JACQUELYNN WAGONER DO
NPI 1184011074
Pediatrics in Fresno, CA

Q: What is Jacquelynn Wagoner's NPI number?

The NPI number for Jacquelynn Wagoner is 1184011074. It was assigned to this individual provider in the NPPES registry on April 19, 2015. The provider is also known as Jacquelynn Crumpacker.

Q: What is Jacquelynn Wagoner's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since April 19, 2015PECOS Enrolled

2823 FRESNO ST, FRESNO, CA 93721(559) 499-6556 Get Directions Write a Review

NPPES record last updated: January 10, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 10, 2020, Oct 29, 2018 (2 updates tracked since 2018).

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About Jacquelynn Wagoner Do NPPES

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

JACQUELYNN WAGONER DO (NPI 1184011074) is an individual pediatrics provider in Fresno, California, licensed in California (20A15405) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184011074

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameJACQUELYNN WAGONERCredential: DO

Location Address2823 FRESNO STFresno, CA 93721-1324

Mailing Address2625 E Divisadero StFresno, CA 93721-1431 · (559) 443-2682 · Fax (559) 443-2681

Phone(559) 499-6556

Sole ProprietorNo

Enumeration DateApril 19, 2015

Last NPPES UpdateJanuary 10, 20202 updates tracked since enumeration

✔ NPI 1184011074 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in CA · 20A15405

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

2823 FRESNO ST, Fresno, CA 93721

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Other Names 1

Former Name (1)Jacquelynn Crumpacker

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacquelynn Wagoner Do 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

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

University Faculty Associates, Inc.

Same address

Emergency Medicine

2823 FRESNO ST
Fresno, CA 93721

Reassigned Medicare billing, California enrollment
320 clinicians in this Medicare group

NPI 1235537283 (559) 443-2682

Central California Faculty Medical Group, Inc.

0.1 mi

Emergency Medicine

2823 FRESNO ST
Fresno, CA 93721

Reassigned Medicare billing, California enrollment
295 clinicians in this Medicare group

NPI 1457603573 (559) 443-2682

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93721 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

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$103.36 typical visit price

range $19.28 – $144.60

Typical copayment $25.84 (range $4.82 – $36.15)

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 20

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

MICHELLE LEA STORKAN M.D.

Emergency Medicine