Andrea Wagner, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704226341 Issued in MI

Practice address

445 N Fenway Dr
Fenton, MI 48430-2666

Phone

(810) 750-6060

NPI assigned

Apr 6, 2017

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Curana Health of Michigan PLLCGroup PAC ID 9638502917, 39 clinicians

CH MSSP Services Mi PLLCGroup PAC ID 2961862800, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Curana Health of Michigan PLLC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1659921278

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• CH MSSP Services Mi PLLC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1609569169
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1972036960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 N FENWAY DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302666",
            "telephone_number": "810-750-6060",
            "fax_number": "810-750-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 N FENWAY DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302666",
            "telephone_number": "810-750-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANDREA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-06",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704226341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diego Velasquez-Plata, DDS, MSD
• VG'S Pharmacy Inc
• VG'S Pharmacy, Inc
• Kellie Marie Vile, PHARMD
• Jacqui Lorraine Wade, RN., BSN
• David Alan Wagner, D.D.S.
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walsh Chiropractic & Wellness Center LLC

• Nurse Practitioner in Fenton, MI
• Providers in Fenton, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.
• 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.