Active NPI
Andrew B Wagg Sr.
- Addiction (Substance Use Disorder) Counselor
- Worcester, MA
National Provider Identifier
1972739787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 585 Lincoln St
Worcester, MA 01605-1906 - Phone
- (508) 854-3320
- Fax
- (508) 853-1264
- NPI assigned
- Jun 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
585 Lincoln St
Worcester, MA 01605-1906
Mailing address
585 Lincoln St
Worcester, MA 01605-1906
Phone (508) 854-3320
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1308785 | Medicaid | MA | |
| 1306421 | Medicaid | MA | |
| M18684 | Other | MA | BLUE CROSS |
| 2220002001 | Other | MA | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244419200000",
"number": "1972739787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "585 LINCOLN ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016051906",
"telephone_number": "508-854-3320",
"fax_number": "508-853-1264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "585 LINCOLN ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016051906",
"telephone_number": "508-854-3320",
"fax_number": "508-853-1264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGG",
"first_name": "ANDREW",
"middle_name": "B",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-08",
"last_updated": "2009-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1308785",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306421",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "M18684",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "2220002001",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.