ETHAN JAMES WAGNER DPT
NPI 1104640879
Physical Therapist in Benton, AR
About Ethan James Wagner Dpt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETHAN JAMES WAGNER DPT (NPI 1104640879) is an individual physical therapist in Benton, Arkansas, licensed in Arkansas (PT5585) and active in the NPI registry since November 2024.
NPPES Registry Identity
Specialties & Licenses
- Diagnose and manage movement dysfunction and enhance physical and functional abilities.
- Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
- Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
- Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
- Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ethan James Wagner Dpt is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ethan Wagner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Rogers, AR 72758
- Reassigned Medicare billing, Arkansas enrollment
- 64 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
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 Ethan Wagner's NPI number?
The NPI number for Ethan Wagner is 1104640879. It was assigned to this individual provider in the NPPES registry on November 11, 2024.
Where is Ethan Wagner located?
Ethan Wagner practices at 20320 I 30 # 190, Benton, AR 72019. The listed phone number is (501) 500-8188.
What is Ethan Wagner's specialty?
The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.
Is Ethan Wagner enrolled in Medicare?
Yes. Ethan Wagner is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ethan Wagner's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ethan Wagner reassigns Medicare benefits to Serc Rehabilitation Partners LLC (Rogers, AR). 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 Ethan Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Ethan Wagner accept?
Health plans from Health Advantage and Octave list Ethan 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 Ethan Wagner was last updated on November 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.