DR. JON ANTHONY WAGNON (NPI# 1265623268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265623268 |
| Entity Type | Individual |
| Full Name | DR. JON ANTHONY WAGNON |
| Credential | D.O. |
| Practice Address |
1368 Dadrian Professional Park Godfrey IL 62035-1685 |
| Practice Telephone | 6184339701 |
| Practice Fax Number | 6184339706 |
| Mailing Telephone | 6184339701 |
| Mailing Fax Number | 6184339706 |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036120316 | IL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 2006033803 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036120316 | 05 |
| Street Address |
1368 DADRIAN PROFESSIONAL PARK |
| City | GODFREY |
| State | IL |
| Zip Code | 62035-1685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710491337 | Mollie Elizabeth Semmer | Physician Assistant | 1368 Dadrian Professional Park, Godfrey, IL 62035-1685 | 2017-11-17 |
| 1972849321 | Kelsey Wickenhauser | Physician Assistant | 1368 Dadrian Professional Park, Godfrey, IL 62035-1685 | 2012-12-12 |
| 1316299332 | Optimal Health Medicine LLC | Family Medicine | 1368 Dadrian Professional Park, Godfrey, IL 62035-1685 | 2012-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548775109 | Bethany E Huelskoetter | Nurse Practitioner | 6702 Godfrey Road, Godfrey, IL 62035 | 2017-12-05 |
| 1720448806 | Sarah Gieszelmann | Nurse Practitioner | 5520 Godfrey Rd Ste B, Godfrey, IL 62035 | 2016-03-02 |
| 1629457536 | Callie Ann Feldman | Occupational Therapy Assistant | 1373 D'adrian Professional Park, Godfrey, IL 62035 | 2015-05-26 |
| 1962767038 | Win U Care for Health | Dietetic Technician, Registered | 321 Big Arch Rd., Godfrey, IL 62035 | 2012-07-05 |
| 1790049831 | Julia Lynn Phillips | Dietetic Technician, Registered | 321 Big Arch Rd, Godfrey, IL 62035 | 2012-07-03 |
| 1578729810 | Home and Environments for Living and Programs | Intermediate Care Facility, Mentally Retarded | 110 N Alby Court, Godfrey, IL 62035 | 2008-08-06 |
| 1497960777 | Joanne T Schulmeister | Dentist | 1203 West Delmar, Godfrey, IL 62035 | 2007-05-11 |
| 1760522965 | Lori Behrens | Social Worker | 5090 Humbert Road, Godfrey, IL 62035 | 2007-02-07 |
| 1699868257 | Beverly Enterprises - Illinois, Inc. | Skilled Nursing Facility | 1623 W. Delmar, #29, Godfrey, IL 62035 | 2006-10-02 |
| 1326147802 | Kymberly Barnard | Speech-Language Pathologist | 6501 Timber Ridge Ln, Godfrey, IL 62035 | 2006-09-21 |
| Find all providers in zip 62035 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952657447 | Edward Stanley Nemec | Family Medicine | 4814 Seine Dr, Godfrey, IL 62035-1622 | 2012-08-02 |
| 1851516306 | Yusuf Ata Mohyuddin | Family Medicine | 1311 Dadrian Professional Park, Godfrey, IL 62035-1686 | 2007-04-17 |
| 1316299332 | Optimal Health Medicine LLC | Family Medicine | 1368 Dadrian Professional Park, Godfrey, IL 62035-1685 | 2012-10-15 |
| 1427332956 | Benedicta I Odemerho | Family Medicine | 5800 Godfrey Rd, Fobes 1525, Godfrey, IL 62035-2426 | 2011-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558969964 | Nicole Kerner | Family Medicine | 310 Brandy Dr, Mackinaw, IL 61755-9707 | 2020-10-16 |
| 1285232991 | Healthy Medical Inc | Family Medicine | 535 N. East St., Suite A, Bradley, IL 60915 | 2020-10-14 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1790390805 | Kimberly Hannah Kupferberg | Family Medicine | 1103 Schaeffer Rd, Long Grove, IL 60047-5153 | 2020-09-15 |
| 1194330977 | Home Doctors for You | Family Medicine | 670 Illinois Blvd, Hoffman Est, IL 60169-3363 | 2020-09-09 |
| 1245844489 | Jovita Zalwango Nassolo | Family Medicine | 116 1/2 N Benton St Apt 2d, Woodstock, IL 60098-3272 | 2020-09-04 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1417565755 | Ghr Total Health and Consulting | Family Medicine | 11336 Mckenna Dr, Frankfort, IL 60423-8096 | 2020-07-22 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.