KELSEY ANNA WAGONER FNP
NPI 1144941758
Nurse Practitioner - Family in Plymouth, IN

Q: What is Kelsey Wagoner's NPI number?

The NPI number for Kelsey Wagoner is 1144941758. It was assigned to this individual provider in the NPPES registry on September 12, 2022.

Q: What is Kelsey Wagoner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Kelsey Wagoner was last updated on November 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since September 12, 2022PECOS EnrolledAccepts Medicare Assignment

209 E JEFFERSON ST, PLYMOUTH, IN 46563(574) 948-5100(574) 335-0745 Get Directions Write a Review

NPPES record last updated: November 9, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 9, 2023, Sep 12, 2022 (2 updates tracked since 2022).

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About Kelsey Anna Wagoner Fnp NPPES

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

KELSEY ANNA WAGONER FNP (NPI 1144941758) is an individual family provider in Plymouth, Indiana, licensed in Indiana (71013346A) and active in the NPI registry since September 2022. She is enrolled in Medicare PECOS, is affiliated with Saint Joseph Regional Medical Center, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1144941758

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKELSEY ANNA WAGONERCredential: FNP

Location Address209 E JEFFERSON STPlymouth, IN 46563-1861

Mailing Address707 Cedar St Ste 405South Bend, IN 46617-2059

Phone(574) 948-5100

Fax(574) 335-0745

Sole ProprietorYes

Medical School CMSOtherGraduated 2022

Enumeration DateSeptember 12, 2022

Last NPPES UpdateNovember 9, 20232 updates tracked since enumeration

NPPES CertifiedNovember 9, 2023

✔ NPI 1144941758 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IN · 71013346A

209 E JEFFERSON ST, Plymouth, IN 46563

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Other Identifiers 2

Other1102690702IN · Anthem

Medicaid300070012IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.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

Kelsey Anna Wagoner Fnp 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 ID2769851872

PECOS Enrollment IDI20221213000715

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.

Areas of Expertise CMS Part B claims 13

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

448 services241 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

144 services144 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

134 services92 patients

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

75 services61 patients

Assessment of emotional or behavioral problems 96127

Assessment of emotional or behavioral problems involves a thorough evaluation of your feelings, thoughts, and behaviors. It's a process where professionals study patterns over time to identify potential issues like anxiety, depression, or other mental health conditions.

35 services17 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

34 services34 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

34 services34 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

30 services30 patients

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

22 services17 patients

Injection of drug or substance under skin or into muscle 96372

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

22 services12 patients

Aspiration and/or injection of fluid from large joint 20610

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

19 services15 patients

Influenza vaccine, inactivated 90653

The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.

17 services17 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

14 services12 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Saint Joseph Regional Medical Center

Acute Care Hospitals · Mishawaka, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number150012

Location5215 Holy Cross PkwyMishawaka, IN 46545 · St. Joseph County

Emergency services Birthing friendly

Memorial Hospital Of South Bend

Acute Care Hospitals · South Bend, IN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number150058

Location615 N Michigan StSouth Bend, IN 46601 · St. Joseph County

Emergency services Birthing friendly

Saint Joseph Regional Medical Center - Plymouth

Acute Care Hospitals · Plymouth, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number150076

Location1915 Lake AvePlymouth, IN 46563 · Marshall County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46563 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

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

MARLA M TROYER FNP

Nurse Practitioner (Family)