Look up the most recent NPI and PECOS records

Brian Lee Wagner

Anesthesiology

Allopathic & Osteopathic Physicians

3315 Watt Ave, Sacramento, CA 95821-3600

PECOS Enrollment

This provider is enrolled in PECOS as BRIAN WAGNER.

Based on the most recent information from CMS, provider Brian Lee Wagner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 10:50 AM.

Profile Details

Provider ID
1205815917
Provider Type
Individual
Full Name
Wagner, Brian Lee
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
1/11/2006
Last Updated
7/8/2007

Contact Information

Practice Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Mailing Location

PO Box 660910, Sacramento, CA 95866-0910

(916) 481-6800

(916) 481-1881

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License A91417 California

Provider Identifiers

ID	Description	Issuer
ID YYY20507Y	Description Medicaid	Issuer Unlisted California

Brian Lee Wagner

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Dickerson, Jaime Lee

Whalen, David Paul

Hauch, Richard D

Moua, Hana

Wright, Richard Gordon

Walther, Henry C

Jain, Ritu

D'Amelio, J David

Metropolitan Anesthesia Consultants, Inc

Weidoff, Paul M