NPIMap

Individual provider Active NPI

Christopher Charles Wagner, DO

  • Family Medicine Physician
  • Shelby, MI
National Provider Identifier
1982134482
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101025520 Issued in MI
Practice address
71 Bevier St
Shelby, MI 49455-1209
Phone
(231) 861-2187
Fax
(231) 861-5100
NPI assigned
Jun 16, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101025520 MI Primary

Addresses

Primary practice location

71 Bevier St
Shelby, MI 49455-1209

Mailing address

PO Box 1848
Muskegon, MI 49443-1848
Phone (231) 672-2119

Other identifiers 1

IdentifierTypeStateIssuer
1982134482MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwagner707781@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200625000682 MI Practitioner - Family Practice 7810267424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health PartnersGroup PAC ID 1456430016, 65 clinicians
Lakeshore Community Hospital IncGroup PAC ID 8224078993, 11 clinicians

Practice addresses (Care Compare)

71 Bevier St
Shelby, MI 49455-1209
Phone (231) 861-2187

Hospital & facility affiliations

  • Trinity Health at Home - Muskegon Home health agency, Muskegon, MI, CCN 237198
  • Mercy Health Lakeshore Campus Hospital, Shelby, MI, CCN 231320
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
  • Corewell Health Ludington Hospital Hospital, Ludington, MI, CCN 230110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Partners CurrentSince Aug 1, 2020 Accepting new patients
Mercy Health Partners CurrentSince Aug 1, 2020 Accepting new patients
Mercy Health Partners Past Accepting new patients

Locations

71 Bevier St
Shelby, MI 49455
Phone (231) 861-2172

Organizations & group practices 11

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1497571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1982134482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1848",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494431848",
            "telephone_number": "231-672-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 BEVIER ST",
            "city": "SHELBY",
            "state": "MI",
            "postal_code": "494551209",
            "telephone_number": "231-861-2187",
            "fax_number": "231-861-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CHRISTOPHER",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-16",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101025520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982134482",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwagner707781@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Lakeshore Shelby MIchgian Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "71 Bevier St",
            "city": "Shelby",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494551209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shelby, MI

Sources for this page

Verify at the official NPI Registry.