DIANE WAGNER
NPI 1194211540
Psychologist - Clinical in Fairfax, VA
About Diane Wagner NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DIANE WAGNER (NPI 1194211540) is an individual clinical provider in Fairfax, Virginia, licensed in Virginia (0810006006) and active in the NPI registry since July 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2017).
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 and accepts Medicare assignment
Diane Wagner 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.
Medicare Billing Reassignments
2Medicare enrollment records show Diane Wagner reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Fairfax, VA 22030
- Reassigned Medicare billing, District of Columbia enrollment
- 15 clinicians in this Medicare group
Fairfax, VA 22031
- Reassigned Medicare billing, District of Columbia enrollment
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 22030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
FAIRFAX, VA 22030
FAIRFAX, VA 22030
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 Diane Wagner's NPI number?
The NPI number for Diane Wagner is 1194211540. It was assigned to this individual provider in the NPPES registry on July 9, 2018.
Where is Diane Wagner located?
Diane Wagner practices at 11325 Random Hills Rd Ste 360, Fairfax, VA 22030. The listed phone number is (703) 646-1518.
What is Diane Wagner's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Diane Wagner enrolled in Medicare?
Yes. Diane Wagner is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Diane Wagner's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Diane Wagner reassigns Medicare benefits to 2 organizations: Clinical Psychology Services PC (Fairfax, VA) and Wagner Psychotherapy LLC (Fairfax, VA). 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 Diane 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 Diane Wagner was last updated on August 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Diane Wagner · NPI 1194211540
Clinical provider in Fairfax, Virginia. Individual provider, active in the CMS NPPES registry since July 9, 2018.
## Identity
- **NPI:** 1194211540 (Entity type: Individual)
- **Enumerated:** July 9, 2018
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 0810006006 (Virginia)
- **Sole proprietor:** No
## Practice location
- **Address:** 11325 RANDOM HILLS RD STE 360, Fairfax, VA 22030-0972
- **Phone:** (703) 646-1518
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Clinical Psychology Services PC (NPI 1194818054, Fairfax, VA); Wagner Psychotherapy LLC (NPI 1962179804, Fairfax, VA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** August 27, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1194211540) · Data from the CMS NPPES public registry.