MR. MARK B. WAGNER CRNA
NPI 1164732053
Nurse Anesthetist, Certified Registered in Grosse Pointe, MI
About Mr. Mark B. Wagner Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. MARK B. WAGNER CRNA (NPI 1164732053) is an individual nurse anesthetist, certified registered in Grosse Pointe, Michigan, licensed in Michigan (4704254851) and active in the NPI registry since October 2010. He is affiliated with Beaumont Hospital - Grosse Pointe and is a graduate of Other (2010).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mr. Mark B. Wagner Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
6Medicare enrollment records show Mark Wagner reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Saint Clair Shores, MI 48081
- Reassigned Medicare billing, Michigan enrollment
- 5 clinicians in this Medicare group
Royal Oak, MI 48073
- Reassigned Medicare billing, Michigan enrollment
- 278 clinicians in this Medicare group
Farmington Hills, MI 48334
- Reassigned Medicare billing, Michigan enrollment
- 199 clinicians in this Medicare group
Novi, MI 48377
- Reassigned Medicare billing, Michigan enrollment
- 188 clinicians in this Medicare group
Novi, MI 48377
- Reassigned Medicare billing, Michigan enrollment
- 192 clinicians in this Medicare group
Irving, TX 75038
- Reassigned Medicare billing, Michigan enrollment
- 905 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 2
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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Beaumont Hospital - Grosse Pointe
Acute Care Hospitals · Grosse Pointe, MIMedicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
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.
GROSSE POINTE, MI 48230
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 Mark Wagner's NPI number?
The NPI number for Mark Wagner is 1164732053. It was assigned to this individual provider in the NPPES registry on October 14, 2010.
Where is Mark Wagner located?
Mark Wagner practices at 468 Cadieux Rd, Grosse Pointe, MI 48230. The listed phone number is (248) 577-3520.
What is Mark Wagner's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Mark Wagner enrolled in Medicare?
Yes. Mark Wagner is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Mark Wagner's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mark Wagner reassigns Medicare benefits to 6 organizations: 12 Mile Surgery Center, PLLC (Saint Clair Shores, MI), William Beaumont Hospital (Royal Oak, MI), Northwestern Services, LLC (Farmington Hills, MI), West Michigan Aas LLC (Novi, MI), Novi Aas LLC (Novi, MI) and 1 more organization, listed in the Medicare section above. 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 Mark Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Mark Wagner affiliated with any hospitals?
According to CMS data, Mark Wagner is affiliated with Beaumont Hospital - Grosse Pointe.
When was this NPI record last updated?
The NPPES record for Mark Wagner was last updated on October 14, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Mr. Mark B. Wagner, CRNA · NPI 1164732053
Nurse Anesthetist, Certified Registered physician in Grosse Pointe, Michigan. Individual provider, active in the CMS NPPES registry since October 14, 2010.
## Identity
- **NPI:** 1164732053 (Entity type: Individual)
- **Enumerated:** October 14, 2010
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 4704254851 (Michigan)
- **Sole proprietor:** No
## Practice location
- **Address:** 468 CADIEUX RD, Grosse Pointe, MI 48230-1507
- **Phone:** (248) 577-3520 · **Fax:** (248) 577-3526
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** 6 organizations under Medicare reassignment (form CMS-855R): 12 Mile Surgery Center, PLLC (NPI 1841059854, Saint Clair Shores, MI); William Beaumont Hospital (NPI 1811044878, Royal Oak, MI); Northwestern Services, LLC (NPI 1083883649, Farmington Hills, MI); West Michigan Aas LLC (NPI 1295149227, Novi, MI); Novi Aas LLC (NPI 1598176919, Novi, MI); and 1 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2010
## Record status
- **NPPES last updated:** October 14, 2010
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Source: [NPI Profile](https://npiprofile.com/npi/1164732053) · Data from the CMS NPPES public registry.