Ian Wagner

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1401 W Pennsylvania St
Allentown, PA 18102-1036

Phone

(484) 640-6431

NPI assigned

Jun 18, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Luke's Physician Group, Inc.

  dba South Mountain Family Practice

  • Family Medicine Physician
  • Bethlehem, PA
  • NPI 1700984622
  Medicare reassignment Care Compare group NPD
• St Luke's Physician Group Inc

  dba St. Luke's Primary Care Orwigsburg

  • Family Medicine Physician
  • Orwigsburg, PA
  • NPI 1710845144
  NPD
• St. Luke's Physician Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bethlehem, PA
  • NPI 1326061581
  NPD
• Clear Lenses Counseling

  • Counselor
  • Orefield, PA
  • NPI 1669141610
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1932725744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 W PENNSYLVANIA ST",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181021036",
            "telephone_number": "484-640-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 W PENNSYLVANIA ST",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181021036",
            "telephone_number": "484-640-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "IAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-18",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Phung Vu
• Naga Jyothi Vulli, M.D.
• Apurva V Vyas, M.D.
• Jamie Wagaman, MA, CSOTS
• Marie Susan Wagener, D.O.
• Jamie Wagner, NP-C
• Lakeisha Wagner, LPN
• Michelle Wagner, RN
• Joel Wagstaff, D.O.
• Samina Wahhab, MD

• Mental Health Counselor in Allentown, PA
• Providers in Allentown, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.