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NICHOLAS BRENNAN WAGNER MD
NPI 1003583642
Student in an Organized Health Care Education/Training Program in Tampa, FL

Active since August 23, 2021PECOS Enrolled
17 DAVIS BLVD STE 308, TAMPA, FL 33606(813) 974-2201 Get Directions Write a Review

NPPES record last updated: May 3, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 3, 2022, Aug 23, 2021 (2 updates tracked since 2021).

About Nicholas Brennan Wagner Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS BRENNAN WAGNER MD (NPI 1003583642) is an individual student in an organized health care education/training program in Tampa, Florida and active in the NPI registry since August 2021. He is enrolled in Medicare PECOS, maintains a secondary practice location in Macon, and is a graduate of Mercer University School Of Medicine (2022).

NPPES Registry Identity

NPI1003583642
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameNICHOLAS BRENNAN WAGNERCredential: MD
Location Address17 DAVIS BLVD STE 308Tampa, FL 33606-3438
Mailing Address17 Davis Blvd Ste 308Tampa, FL 33606-3438 · (813) 974-2201
Phone(813) 974-2201
Sole ProprietorNo
Medical School CMSMercer University School Of MedicineGraduated 2022
Enumeration DateAugust 23, 2021
Last NPPES UpdateMay 3, 20222 updates tracked since enumeration
NPPES CertifiedMay 3, 2022
✔ NPI 1003583642 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
17 DAVIS BLVD STE 308, Tampa, FL 33606
Open in Google Maps ↗

Secondary Practice Location 1

Location 11550 College StMacon, GA 31207-1500 · Phone (478) 301-2600

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Cigna Healthcare, Cigna HealthCare of Florida, Inc., Oscar Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Brennan Wagner Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4981184934
PECOS Enrollment IDI20260218000272
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Wagner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mori Bean And Brooks Inc
4.0 mi
Diagnostic Radiology
1 TAMPA GENERAL CIR
Tampa, FL 33606
  • Reassigned Medicare billing, Florida enrollment
  • 1,130 clinicians in this Medicare group
NPI 1093782070 (904) 236-5884

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARISOL GOMEZ MD
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (727) 462-7000
DR. SARA KHAN MD
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 974-2202
PETER BRANDON DOMINGUEZ MD
Emergency Medicine
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 844-7000
JACOB ALEXANDER KALIN DO
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 844-7000
MICHAEL BRANDON CISNEROS MD
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 974-2201
DR. SANTIAGO BEJARANO HERNANDEZ MD, MPH
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 844-7000
LIDIA ODALIS LOPEZ
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 974-2201
NATALIE JUN BALES MD
Student in an Organized Health Care Education/Training Program
17 DAVIS BLVD STE 308
TAMPA, FL 33606
Hillsborough County (813) 974-2201

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Wagner's NPI number?

The NPI number for Nicholas Wagner is 1003583642. It was assigned to this individual provider in the NPPES registry on August 23, 2021.

Where is Nicholas Wagner located?

Nicholas Wagner practices at 17 Davis Blvd Ste 308, Tampa, FL 33606. The listed phone number is (813) 974-2201.

What is Nicholas Wagner's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Nicholas Wagner enrolled in Medicare?

Yes. Nicholas Wagner is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicholas Wagner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Wagner reassigns Medicare benefits to Mori Bean And Brooks Inc (Tampa, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nicholas Wagner accept?

Health plans from Cigna HealthCare of Florida, Inc., Cigna Healthcare, Oscar Health, Oscar Health Maintenance Organization of Florida and Oscar Insurance Company list Nicholas Wagner as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicholas Wagner was last updated on May 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.