Jess Bruce Wagner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME125237 Issued in FL

Practice address

1320 Ribaut Rd
Port Royal, SC 29935-1118

Phone

(843) 986-0900

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

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.

• Beaufort Jasper Hampton Comprehensive Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ridgeland, SC
  • NPI 1649276148
  Medicare reassignment NPD
• Carolinas Physicians Network Inc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment NPD
• Beaufort Jasper Hampton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Varnville, SC
  • NPI 1073318259
  NPD
• Carolinas Physicians Network Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544
  NPD
• Carolinas Physicians Network Inc

  • Internal Medicine Physician
  • Mooresville, NC
  • NPI 1811151244
  NPD
• Doctors Care, PA

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1366499048
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1942301593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 RIBAUT RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351118",
            "telephone_number": "843-986-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "307 Boatner Rd Ste 114",
            "address_purpose": "LOCATION",
            "city": "Eglin AFB",
            "state": "FL",
            "postal_code": "325421302",
            "country_code": "US",
            "telephone_number": "850-883-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESS",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "28789",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME125237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylie Shai Thorstad
• Annsley Marie Troxell, PA-C
• Chih-Ping Tucker, PHARMD
• Karmen Turner, PNP
• Nicholas Vanderhoof
• Monica Walker, FNP-C
• Faith Wallace, DDS
• Dorothy Alicia Wheeler, PT, DPT
• Kara Raye White
• Allison Lee Wigfield

• Internal Medicine Physician in Port Royal, SC
• Providers in Port Royal, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.