Emily Wagner
Individual provider Active NPI Physician Assistant · Brooklyn, IA
NPI 1982019865 · NPPES record last updated Jun 30, 2014
Key facts
- NPI
- 1982019865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 128 Jackson St
Brooklyn, IA 52211-7711 - Phone
- (641) 522-7221
- NPI assigned
- Jun 30, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
-
Brian J Heineman, DO
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
128 Jackson St
Brooklyn, IA 52211-7711
Hospital & facility affiliations
- Grinnell Regional Medical Center
- Compass Memorial Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140807000245 | IA | Practitioner - Physician Assistant | 9032336565 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brian J. Heineman, D.O. | Past |
Accepting new patients | |
| Marengo Memorial Hospital | Physician Assistant | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
128 Jackson St
Brooklyn, IA 52211-7711
Mailing address
128 Jackson St
Brooklyn, IA 52211-7711
Phone (641) 522-7221
Other providers in Brooklyn, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.