Individual provider Active NPI

Daniel Lee Wagner, MD

  • Cardiovascular Disease Physician
  • Saint Louis, MO
National Provider Identifier
1942419452
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2009013467 Issued in MO
Practice address
3023 N Ballas Rd Ste 200D
Saint Louis, MO 63131-2328
Phone
(314) 996-7272
NPI assigned
May 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 2009013467 MO Primary

Addresses

Primary practice location

3023 N Ballas Rd Ste 200D
Saint Louis, MO 63131-2328

Mailing address

3023 N Ballas Rd Ste 200D
Saint Louis, MO 63131-2328
Phone (314) 996-7272

Other practice location 1

1011 Bowles Ave Ste 205
Fenton, MO 63026-2387
Phone (636) 496-5065

Other practice location 2

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 458-8899

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
Direct Messaging Address dwagner89126@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20091013000131 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3173669736 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Maryland School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5772

3023 N Ballas Rd
Suite 200D
Saint Louis, MO 63131-2328
Phone (314) 996-7272

Hospital & facility affiliations

  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Barnes-Jewish West County Hospital Hospital, Creve Coeur, MO, CCN 260162
  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Cardiovascular Disease CurrentSince Jan 28, 2022 Accepting new patients
Physician Groups LC CurrentSince Jan 28, 2022 Accepting new patients
SSM Health Care St Louis Cardiovascular Disease CurrentSince Aug 16, 2014 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Inpatient Specialists PA Past Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1011 Bowles Ave
Ste 205
Fenton, MO 63026
Phone (314) 966-8118

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

3844 S Lindbergh Blvd
Saint Louis, MO 63127
Phone (314) 525-0420

3844 S Lindbergh Blvd
Ste 220
Saint Louis, MO 63127
Phone (314) 569-2620

8820 Manchester Rd
Saint Louis, MO 63144
Phone (314) 963-8100

3023 N Ballas Rd
Ste 200D
Saint Louis, MO 63131
Phone (314) 996-7272

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1942419452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3023 N BALLAS RD STE 200D",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312328",
            "telephone_number": "314-996-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 N BALLAS RD STE 200D",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312328",
            "telephone_number": "314-996-7272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 Bowles Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Fenton",
            "state": "MO",
            "postal_code": "630262387",
            "country_code": "US",
            "telephone_number": "636-496-5065",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "314-362-4278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DANIEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2009013467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3023 N Ballas Rd Ste 200D",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwagner89126@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dwagner89126@direct-ehr-ssmhc.com",
            "address_1": "1011 Bowles Ave Ste 205",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262387",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1011 Bowles Ave Ste 205",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.