Jordan Wagner, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

269194 Issued in AZ

Practice address

1117 E Devonshire Ave
Hemet, CA 92543-3083

Phone

(951) 652-2811

NPI assigned

Apr 12, 2022

Sex

Male

Sole proprietor

Yes

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 CA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Seven Star Hospital Associates IncGroup PAC ID 4789083338, 129 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hemet Global Medical Center Hospital, Hemet, CA, CCN 050390

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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.

• Seven Star Hospital Associates Inc.

  dba Seven Star Radiology

  • Diagnostic Radiology Physician
  • Hemet, CA
  • NPI 1043813140
  Medicare reassignment Care Compare group NPD
• Seven Star Hospital Associates Inc.

  • Anesthesiology Physician
  • Hemet, CA
  • NPI 1407459506
  NPD

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

• KPC Global Medical Centers, Inc.

  dba Hemet Global Medical Center

  • General Acute Care Hospital
  • Hemet, CA
  • NPI 1114239068
  Care Compare affiliation

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1952043689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3477 AMBER LN",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564844",
            "telephone_number": "775-450-7238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 E DEVONSHIRE AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925433083",
            "telephone_number": "951-652-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JORDAN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "269194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thuy-Anh Vu
• Stephanie Vuong, DO
• W Joseph Atiya MD
• W. Wasef Atiya
• Pamela Marie Wachholz, D.C.
• Tifani Wagner, MD
• Jacinta Wanjiru Wainaina, RN
• Walgreen Co (Walgreens #05038)
• Walgreen Co (Walgreens #01081)
• Walgreen Co (Walgreens #01080)

• Certified Registered Nurse Anesthetist in Hemet, CA
• Providers in Hemet, CA by specialty
• Certified Registered Nurse Anesthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.