JORDAN M WAGNER (NPI# 1831383074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831383074 |
| Entity Type | Individual |
| Full Name | JORDAN M WAGNER |
| Other Name | JORDAN M FRIZZO |
| Credential | PA |
| Practice Address |
2002 S 11th St Niles MI 49120-4074 |
| Mailing Address |
6416 Deans Hill Rd Berrien Center MI 49102-9750 |
| Practice Telephone | 2696870200 |
| Practice Fax Number | 2696840199 |
| Mailing Telephone | 2694717741 |
| Mailing Fax Number | 2694711581 |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2013-03-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5601005116 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1831383074 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760939136 | Jordan Ann Wagner | Specialist/Technologist | 3351 Fallston Rd, Fallston, MD 21047-1020 | 2016-09-02 |
| 1447713185 | Jordan Jay Wagner | Pharmacist | 2350 Hospital Dr, Webster City, IA 50595-6600 | 2019-04-10 |
| 1558870881 | Jordan Wagner | Physician Assistant | 2975 Roslyn St, Denver, CO 80238-3325 | 2017-09-29 |
| 1558590679 | Jordan Wagner | Emergency Medicine | 1493 Cambridge St, Cambridge, MA 02139-1047 | 2009-07-10 |
| Street Address |
2002 S 11TH ST |
| City | NILES |
| State | MI |
| Zip Code | 49120-4074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265478192 | Daniel M Metzger | Specialist | 2002 S 11th St, Niles, MI 49120-4074 | 2006-06-20 |
| 1922621556 | Angela Coleman | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2020-05-18 |
| 1861988180 | Carrie Lozmack | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2018-07-10 |
| 1275988867 | Joan Madsen | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2016-05-02 |
| 1174984413 | Amanda Leigh Mills | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2016-03-15 |
| 1538592753 | Lakeland Community Hospital Watervliet | Clinic/Center | 2002 S 11th St, Niles, MI 49120-4074 | 2013-08-12 |
| 1164764155 | Jennifer Ann Layman-young | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2013-03-18 |
| 1083960652 | Lauren-shylene Luna Toscano | Nurse Practitioner | 2002 S 11th St, Niles, MI 49120-4074 | 2012-08-01 |
| 1124394945 | Elizabeth Ann Mcglothlin | Family Medicine | 2002 S 11th St, Niles, MI 49120-4074 | 2012-03-26 |
| 1548588031 | Lakeland Medical Practices | Clinic/Center | 2002 S 11th St, Niles, MI 49120-4074 | 2010-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093285652 | The Caerus Group LLC | Clinic/Center | 732 S. 11th St #197, Niles, MI 49120 | 2018-11-27 |
| 1306316971 | Vicki L Yarbro | Physical Therapist | 6 Longmeadow Village Dr. Suite 3, Niles, MI 49120 | 2018-11-27 |
| 1063831469 | Aaron Joseph Lanning | Nurse Practitioner | 42 N Saint Joseph Ave Ste 300, Niles, MI 49120 | 2014-04-14 |
| 1740601186 | Terrianne Klaeren | Occupational Therapist | 1009 Almaugus Drive, Niles, MI 49120 | 2014-01-03 |
| 1124469366 | All Needs Senior Services, Inc. | Home Health | 1723 Pucker Street Dr, Suite A, Niles, MI 49120 | 2013-07-16 |
| 1902105034 | Nile Family Pharmacy LLC | Pharmacy | 70 E. State St., Niles, MI 49120 | 2011-03-15 |
| 1629240734 | Karen L Palmer | Counselor | 115 S St Joseph Ave, Niles, MI 49120 | 2008-03-28 |
| 1124218391 | Melissa A Longley | Social Worker | 333 N. Second Street, Suite 303, Niles, MI 49120 | 2007-07-25 |
| 1841410727 | Periza Zaninovic | Dentist | 123 Marmont Street, Niles, MI 49120 | 2007-04-26 |
| 1477629087 | Stephen Williams Tankersley | Dentist | 226 S Lincoln Ave, Niles, MI 49120 | 2006-11-27 |
| Find all providers in zip 49120 | ||||
| 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 |
|---|---|---|---|---|
| 1194378588 | Breann J Melago | Family Medicine | 1875 Taft Ave, Niles, OH 44446-4117 | 2019-07-24 |
| 1215459235 | John Mourad Zakhary | Family Medicine | 1951 Oak St, Niles, MI 49120-3738 | 2017-07-11 |
| 1962935924 | Physician Management Services of Illinois, LLC | Family Medicine | 7900 N Milwaukee Ave Ste 2-33, Niles, IL 60714-3240 | 2017-04-06 |
| 1609183045 | Peter F Mckay | Family Medicine | 2122 Robbins Ave Apt 138, Niles, OH 44446-3968 | 2010-09-07 |
| 1053559898 | Chicago Mental Health Day Program and Wellness Clinic | Family Medicine | 8926 Greenwood, Suite 167, Niles, IL 60714 | 2009-02-02 |
| 1710105671 | Margaret Marie Dolan | Family Medicine | 9016 W Heathwood Cir, Niles, IL 60714-5807 | 2007-04-23 |
| 1306967724 | Guntippar S Pratumngern | Family Medicine | 7255 N Caldwell Ave, Niles, IL 60714-4501 | 2007-04-03 |
| 1316079593 | Romeo Lagrosa | Family Medicine | 8965 W Golf Rd, Niles, IL 60714-5812 | 2007-03-12 |
| 1376690438 | Phillip Paul Malvasi | Family Medicine | 1017 Youngstown Warren Rd, Niles, OH 44446-4620 | 2007-01-04 |
| 1700981537 | Yang W Yeom | Family Medicine | 8965 Golf Road, Niles, IL 60714 | 2006-09-14 |
| Find all providers in NILES | ||||
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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.