DR. BLAKE DOUGLAS WAGNER JR. PH.D.
NPI 1013069061
Psychologist in Mansfield, OH

Active since January 18, 2007PECOS EnrolledAccepts Medicare Assignment
1575 MARION AVE, MANSFIELD, OH 44906(419) 529-9941(419) 529-0496 Get Directions Write a Review

NPPES record last updated: September 2, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Blake Douglas Wagner Jr. Ph.d. NPPES

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

DR. BLAKE DOUGLAS WAGNER JR. PH.D. (NPI 1013069061) is an individual psychologist in Mansfield, Ohio, licensed in Ohio (I-4127) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1988).

NPPES Registry Identity

NPI1013069061
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. BLAKE DOUGLAS WAGNER JR.Credential: PH.D.
Location Address1575 MARION AVEMansfield, OH 44906-3409
Mailing Address1575 Marion AveMansfield, OH 44906-3409 · (419) 529-9941 · Fax (419) 529-0496
Fax(419) 529-0496
Sole ProprietorNo
Medical School CMSOtherGraduated 1988
Enumeration DateJanuary 18, 2007
Last NPPES UpdateSeptember 2, 2008
NPI 1013069061 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in OH · I-4127
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

1575 MARION AVE, Mansfield, OH 44906

Other Identifiers 3

Other000000315185Anthem
Medicare UPINR71967
Medicare PINCP12492

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Blake Douglas Wagner Jr. Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3971498205
PECOS Enrollment IDI20040218000255
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.

Other Providers at the Same Location NPPES 5

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

Counselor
1575 MARION AVE
MANSFIELD, OH 44906
Counselor
1575 MARION AVE
MANSFIELD, OH 44906
Counselor
1575 MARION AVE
MANSFIELD, OH 44906
Counselor
1575 MARION AVE
MANSFIELD, OH 44906
Counselor (Mental Health)
1575 MARION AVE
MANSFIELD, OH 44906

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 Blake Wagner's NPI number?

The NPI number for Blake Wagner is 1013069061. It was assigned to this individual provider in the NPPES registry on January 18, 2007.

Where is Blake Wagner located?

Blake Wagner practices at 1575 Marion Ave, Mansfield, OH 44906. The listed phone number is (419) 529-9941.

What is Blake Wagner's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Blake Wagner enrolled in Medicare?

Yes. Blake Wagner is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Blake Wagner accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Oscar Health Insurance and Oscar Insurance Corporation of Ohio and 2 other insurers list Blake 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 Blake Wagner was last updated on September 2, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.