Individual provider Active NPI

Daniel Wagoner

  • Family Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1952070799
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28226050A Issued in IN
Practice address
8902 N Meridian St Ste 101
Indianapolis, IN 46260-5306
Phone
(317) 848-8048
NPI assigned
Sep 7, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28226050A IN Primary
Nurse Practitioner 363L00000X 71011659A IN

Addresses

Primary practice location

8902 N Meridian St Ste 101
Indianapolis, IN 46260-5306

Mailing address

PO Box 637764
Cincinnati, OH 45263-7764
Phone (317) 880-3939

Other practice location 1

720 Eskenazi Ave
Indianapolis, IN 46202-5187
Phone (317) 880-7666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210910001587 IN Practitioner - Nurse Practitioner 8426454745 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eskenazi Medical Group IncGroup PAC ID 4284546813, 134 clinicians

Practice addresses (Care Compare)

720 Eskenazi Ave
Indianapolis, IN 46202-5187
Phone (317) 880-7666

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.69 of 100Reported as group
Quality
80.42
Promoting interoperability
100
Improvement activities
40
Cost
81.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71011659AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eskenazi Medical Group Inc Nurse Practitioner CurrentSince Mar 7, 2022 Accepting new patients

Locations

720 Eskenazi Ave
Bldg 5TH
Indianapolis, IN 46202
Phone (317) 880-3818

720 Eskenazi Ave
Indianapolis, IN 46202
Phone (317) 880-0000

720 Eskenazi Ave
Fl 5
Indianapolis, IN 46202
Phone (317) 880-6000

Organizations & group practices 1

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 2

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": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1952070799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637764",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452637764",
            "telephone_number": "317-880-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8902 N MERIDIAN ST STE 101",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462605306",
            "telephone_number": "317-848-8048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 Eskenazi Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025187",
            "country_code": "US",
            "telephone_number": "317-880-7666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-07",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28226050A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71011659A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.