Individual provider Active NPI

Nikita Wagle, MD

  • Physical Medicine & Rehabilitation Physician
  • Bridgeton, MO
National Provider Identifier
1932761095
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2023033486 Issued in MO
Practice address
12380 De Paul Dr
Bridgeton, MO 63044-2511
Phone
(314) 447-9700
NPI assigned
Jun 28, 2019
Last updated
Dec 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 2023033486 MO Primary

Addresses

Primary practice location

12380 De Paul Dr
Bridgeton, MO 63044-2511

Mailing address

1776 Woodstead CT Ste 208
The Woodlands, TX 77380-1480
Phone (281) 724-3050

Other practice location 1

100 Medical Plz
Lake St Louis, MO 63367-1366
Phone (636) 625-5200

Other practice location 2

6420 Clayton Rd
Saint Louis, MO 63117-1811
Phone (314) 768-5200

Other identifiers 1

IdentifierTypeStateIssuer
200131311MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230920003929 MO Practitioner - Physical Medicine and Rehabilitation 0749512481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Indiana University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Post-Acute Physicians of Missouri, PCGroup PAC ID 6002121126, 12 clinicians

Practice addresses (Care Compare)

100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2023033486MOMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Post-Acute Physicians of Missouri PC Physical Medicine & Rehabilitation CurrentSince Oct 1, 2023 Accepting new patients
SSM Select Rehab St Louis LLC Past Accepting new patients

Locations

12380 De Paul Dr
Bridgeton, MO 63044
Phone (314) 447-9700

100 Medical Plz
Lake St Louis, MO 63367
Phone (636) 625-5200

100 Medical Plz
Fl 5
Lake St Louis, MO 63367
Phone (636) 625-5200

2800 Hospital Dr
North Kansas City, MO 64116
Phone (816) 221-5050

1027 Bellevue Ave
Saint Louis, MO 63117
Phone (314) 645-6450

1776 Woodstead Ct
Ste 208
The Woodlands, TX 77380
Phone (281) 724-3100

Organizations & group practices 2

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

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1932761095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 WOODSTEAD CT STE 208",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773801480",
            "telephone_number": "281-724-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12380 DE PAUL DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442511",
            "telephone_number": "314-447-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Medical Plz",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633671366",
            "country_code": "US",
            "telephone_number": "636-625-5200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6420 Clayton Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631171811",
            "country_code": "US",
            "telephone_number": "314-768-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGLE",
        "first_name": "NIKITA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2023033486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200131311",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.