Benjamin Wagner

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPCCANDIDATE11099 Issued in OK

Practice address

13707 Fairhill Ave
Edmond, OK 73013-1946

Phone

(405) 412-3494

NPI assigned

Oct 28, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13010/brand/1/csg/1/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.

• Norman Behavioral Health Group, LLC

  • Psychologist
  • Norman, OK
  • NPI 1194714972
  Medicare reassignment NPD
• Pathways Medical LLC

  • Primary Care Clinic/Center
  • Edmond, OK
  • NPI 1194185090
  NPD
• Pathways Professional Counseling LLC

  • Community/Behavioral Health Agency
  • Oklahoma City, OK
  • NPI 1043392558
  NPD

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1982311056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13707 FAIRHILL AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730131946",
            "telephone_number": "405-412-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13707 FAIRHILL AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730131946",
            "telephone_number": "405-412-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BENJAMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "LPCCANDIDATE11099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE BOARD",
            "identifier": "LPCCANDIDATE11099",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Waddle, COTA
• Ashley Elise Wade
• Nicole R Wade, PTA
• Jordyn Nicole Wadley
• Emmanuel Wadmia
• Cynthia Ann Wagner, R.M.T.
• Derrick Durell Wagoner, D.O.
• Elizabeth Wagoner, DPH
• Wal-Mart Stores East , LP (Walmart Vision Center 30-2803)
• Wal-Mart Stores East , LP (Walmart Pharmacy 10-0389)

• Mental Health Counselor in Edmond, OK
• Providers in Edmond, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.