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DR. MATTHEW ROBERT WAGNER MD
NPI 1114198751
Orthopaedic Surgery - Pediatric Orthopaedic Surgery in Port Jefferson Station, NY

Active since March 21, 2008PECOS Enrolled
1500 ROUTE 112 BLDG 2C, PORT JEFFERSON STATION, NY 11776(631) 371-8034(631) 828-7899 Get Directions Write a Review

NPPES record last updated: November 5, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Matthew Robert Wagner Md NPPES

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

DR. MATTHEW ROBERT WAGNER MD (NPI 1114198751) is an individual pediatric orthopaedic surgery provider in Port Jefferson Station, New York, licensed in New York (251727) and active in the NPI registry since March 2008. He is enrolled in Medicare PECOS and maintains a secondary practice location in Commack.

NPPES Registry Identity

NPI1114198751
Entity TypeIndividualMale
Primary Taxonomy207XP3100X
Provider Legal NameDR. MATTHEW ROBERT WAGNERCredential: MD
Location Address1500 ROUTE 112 BLDG 2CPort Jefferson Station, NY 11776-8055
Mailing Address1500 Route 112 Bldg 2cPort Jefferson Station, NY 11776-8055 · (631) 371-8034 · Fax (631) 828-7899
Phone(631) 371-8034
Fax(631) 828-7899
Sole ProprietorYes
Enumeration DateMarch 21, 2008
Last NPPES UpdateNovember 5, 2019
✔ NPI 1114198751 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Pediatric Orthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207XP3100X
Licenses✔ Licensed in NY · 251727✔ Licensed in FL · ME103612
Definition
An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones.
1500 ROUTE 112 BLDG 2C, Port Jefferson Station, NY 11776
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Secondary Practice Location 1

Location 1500 Commack Rd Unit 150Commack, NY 11725-5009 · Phone (631) 371-8034 · Fax (631) 828-7899

Other Identifiers 1

Other120130521000407NY · Medicare

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Matthew Robert Wagner Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignments

2

Medicare enrollment records show Matthew Wagner reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

St. Charles Hospital Corp.
2.7 mi
General Acute Care Hospital
200 BELLE TERRE RD
Port Jefferson, NY 11777
  • Reassigned Medicare billing, New York enrollment
  • 210 clinicians in this Medicare group
NPI 1497765630 (631) 474-6000
Chs Physician Partners, P.C
13 mi
Family Medicine
213 MONTAUK HWY
West Sayville, NY 11796
  • Reassigned Medicare billing, New York enrollment
  • Medicare enrollment name: Chs Physician Partners PC
  • 944 clinicians in this Medicare group
NPI 1679823512 (631) 563-6205

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

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

LIDIA ANI
Orthopaedic Surgery (Adult Reconstructive Orthopaedic Surgery)
1500 ROUTE 112 BLDG 2C
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 828-7220

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 Matthew Wagner's NPI number?

The NPI number for Matthew Wagner is 1114198751. It was assigned to this individual provider in the NPPES registry on March 21, 2008.

Where is Matthew Wagner located?

Matthew Wagner practices at 1500 Route 112 Bldg 2C, Port Jefferson Station, NY 11776. The listed phone number is (631) 371-8034.

What is Matthew Wagner's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Pediatric Orthopaedic Surgery, with taxonomy code 207XP3100X.

Is Matthew Wagner enrolled in Medicare?

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

Which organizations bill Medicare for Matthew Wagner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Wagner reassigns Medicare benefits to 2 organizations: St. Charles Hospital Corp. (Port Jefferson, NY) and Chs Physician Partners, P.C (West Sayville, NY). Each 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 Matthew Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Matthew Wagner was last updated on November 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.