Peter John Wagner, M.D.

Primary specialty

Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X

License

C130554 Issued in CA

Practice address

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221

Phone

(760) 837-8767

Fax

(760) 837-8806

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

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.

• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  Medicare reassignment NPD
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Cathedral City, CA
  • NPI 1407007537
  NPD
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Cathedral City, CA
  • NPI 1629384615
  NPD
• Tropical Texas Behavioral Health

  • Community/Behavioral Health Agency
  • Edinburg, TX
  • NPI 1093916835
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1962403774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-837-8767",
            "fax_number": "760-837-8806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-837-8767",
            "fax_number": "760-837-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PETER",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "CA",
            "license": "C130554",
            "primary": true
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "CO",
            "license": "36158",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "36158",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C130554",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11902761",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phuong Vu, DMD
• Manasa Vulchi, M.D.
• Christopher Vuong, M.D.
• Phiyen Vutran
• Krutarth Vyas, PHD.
• Wynne Josephine Wakoli, NP
• David John Waldman, M.D.
• Erin Waldum, RN
• Walgreen Co
• Walgreen Co

• Behavioral Neurology & Neuropsychiatry Physician in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Behavioral Neurology & Neuropsychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.