Andrew Stephen Wagner (NPI# 1285722819, PAC ID# 8527077841) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1285722819 |
| PAC ID by PECOS | 8527077841 |
| Professional Enrollment ID | I20060414000064 |
| Full Name | Andrew Stephen Wagner |
| Address |
819 Longwood Ln Sebastopol CA 95472-2734 |
| Phone Number | 7078276320 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF CALIFORNIA, CALIFORNIA COLLEGE OF MEDICINE |
| Graduation Year | 1982 |
| Primary Specialty | FAMILY MEDICINE |
| Secondary Specialties | HOSPICE/PALLIATIVE CARE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050174 | SANTA ROSA MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 819 Longwood Ln, Sebastopol, CA 95472-2734 | 7078276320 |
| Street Address |
819 LONGWOOD LN |
| City | SEBASTOPOL |
| State | CA |
| Zip | 95472-2734 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nancy A Davidson | Family Practice | 6800 Palm Ave, Suite A, Sebastopol, CA 95472-2446 | |
| Brian P Jacobs | Clinical Social Worker | 868 Gravenstein Hwy N, Sebastopol, CA 95472-2810 | |
| David Perry Molencupp | Chiropractic | 868 Gravenstein Hwy N, Sebastopol, CA 95472-2810 | |
| Barry Lynn Lutz | Optometry | 868 Gravenstein Hwy N, Sebastopol, CA 95472-2810 | |
| Richard S Schechter | Chiropractic | 868 Gravenstein Hwy N, Sebastopol, CA 95472-2810 | |
| Larry A Smith | Podiatry | 1035 Gravenstein Hwy N, Sebastopol, CA 95472-2811 | |
| Norman J Mintz | Optometry | 825 Gravenstein Hwy N, Suite 7, Sebastopol, CA 95472-2844 | |
| Julie Smith | Physical Therapy | 100 Pleasant Hill N, Sebastopol1, CA 95472-3104 | |
| Patricia D Martinez | Physical Therapy | 100 Pleasant Hill N Ave, Sebastopol, CA 95472-3104 | |
| Mark S Lovett | Physical Therapy | 100 Pleasant Hill N Ave, Sebastopol, CA 95472-3104 | |
| Find all physicians in zip 95472 | |||
| City | SEBASTOPOL |
| Zip Code | 95472 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | SEBASTOPOL + FAMILY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.