Katherine Elise Wagner, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110010298 Issued in VA

Practice address

8301 Old Courthouse Rd
Vienna, VA 22182-3804

Phone

(703) 442-0300

Fax

(703) 442-0337

NPI assigned

Jun 10, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Vienna, VA
  • NPI 1891169975

  DC

  Medicare reassignment Care Compare group
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385

  Multi-Specialty

  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Bethesda, MD
  • NPI 1518480136
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Cedar Rapids, IA
  • NPI 1316342611
  NPD (past)
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1972345072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8301 OLD COURTHOUSE RD",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823804",
            "telephone_number": "703-442-0300",
            "fax_number": "703-442-0337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KATHERINE",
        "middle_name": "ELISE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KatherineE.Wagner@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "8301 Old Courthouse Rd",
            "city": "Vienna",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221823804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Khai Dinh Vu, D.D.S
• Nguyen Ngoc Thi Vu, PA-C
• Cailin Marie Vuolo, DPT
• W & J DC LLC
• Abeygael M Wachira
• Wakil Qarar
• Wal-Mart Stores East LP
• Walgreen Co
• Walgreen Co
• Christina Walker, CFY-SLP

• Physician Assistant in Vienna, VA
• Providers in Vienna, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.