Michael A Wagnon, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

K7486 Issued in TX

Practice address

225 E Beauregard Ave
San Angelo, TX 76903-5920

Phone

(325) 658-1511

NPI assigned

Oct 25, 2005

Sex

Male

Sole proprietor

No

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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwagnon8667@shannonhealth.direct-ci.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Shannon Clinic

  • Rural Health Clinic/Center
  • Ozona, TX
  • NPI 1245230465

  Corporate Director

  CMS ownership

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.

• Shannon Clinic

  • Family Medicine Physician
  • San Angelo, TX
  • NPI 1770587149

  Pediatrics

  Medicare reassignment NPD
• Shannon Clinic

  • Pediatrics Physician
  • Del Rio, TX
  • NPI 1790986719
  NPD
• Shannon Medical Center

  • General Acute Care Hospital
  • San Angelo, TX
  • NPI 1992707228
  NPD (past)

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1992795645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E BEAUREGARD AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035920",
            "telephone_number": "325-658-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNON",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K7486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142727001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krishna Vukoti, BS(PHARM), MTECH PHD
• Marius Vulcan, M.D.
• W.Gordy Day,M.D.LLC
• George Kevin Wade, LCSW
• Kendall K Wadsworth, M.S., LPC
• Morgan Blake Wake, PA-C
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas LLC

• Pediatrics Physician in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.