Kathleen Therese Wagner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9669 Issued in NV

Practice address

4920 W Lone Mountain Rd
Las Vegas, NV 89130

Phone

(702) 655-0550

Fax

(702) 655-0545

NPI assigned

Jun 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kathleen.wagner.1@14940.direct.athenahealth.com

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.

• Kathleen T. Wagner, MD, PC

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1932379344
  NPD (past) Authorized official
• Healthcare Partners Medical Group Coats LTD

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1487631917
  NPD
• Intermountain Medical Holdings Nevada Inc

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279

  Family Medicine

  NPD (past)
• Unsom Multi-Spec GRP Pract S

  • Surgery Physician
  • Henderson, NV
  • NPI 1053739268

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1952342933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98978",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891938978",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 W LONE MOUNTAIN RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89130",
            "telephone_number": "702-655-0550",
            "fax_number": "702-655-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KATHLEEN",
        "middle_name": "THERESE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2018-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "9669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9669",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018691",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952342933",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Wagner
• James M Wagner, DDS
• Jeffrey G Wagner, M.D.
• Jennifer Wagner, CNM
• Katelyn Wagner
• Maria Rebeca Wagner
• Olivia Leigh Wagner, RN
• Patrick Wagner, PT, DPT
• Peter Wagner
• Riley James Wagner

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; 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.