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DIANE WAGNER
NPI 1194211540
Psychologist - Clinical in Fairfax, VA

Active since July 09, 2018PECOS EnrolledAccepts Medicare Assignment
11325 RANDOM HILLS RD STE 360, FAIRFAX, VA 22030(703) 646-1518 Get Directions Write a Review

NPPES record last updated: August 27, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 27, 2021, Jul 9, 2018 (2 updates tracked since 2018).

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

NPI1194211540
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDIANE WAGNER
Location Address11325 RANDOM HILLS RD STE 360Fairfax, VA 22030-0972
Mailing Address10911 Adare DrFairfax, VA 22032-3105 · (703) 646-1518
Phone(703) 646-1518
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateJuly 9, 2018
Last NPPES UpdateAugust 27, 20212 updates tracked since enumeration
NPPES CertifiedAugust 27, 2021
✔ NPI 1194211540 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in VA · 0810006006
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
11325 RANDOM HILLS RD STE 360, Fairfax, VA 22030
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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

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.

PECOS PAC ID9830448844
PECOS Enrollment IDI20180824001661
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.

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.

New Patient
$194.86 typical visit price
range $65.18 – $194.86
Typical copayment $48.71 (range $16.29 – $48.71)
Most-billed visit code 99205
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
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 7

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

DR. DAVID W RUXER PHD
Psychologist
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 691-1326
MEGAN LYNN DAVIS PSY.D.
Psychologist (Clinical)
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 691-1326
FACE IT COUNSELING SERVICES, LLC
Counselor (Professional)
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 957-8975
MS. NICOLE M. RAINES
Marriage & Family Therapist
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (626) 788-2121
HABLEE HOME CARE & SERVICES LLC
In Home Supportive Care
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 225-3366
DR. SUSAN A MURDOCK PSYD
Psychologist
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 691-1326
DR. STEVEN BRIAN TUNICK PHD
Psychologist (Clinical)
11325 RANDOM HILLS RD STE 360
FAIRFAX, VA 22030
Fairfax City (703) 691-1326

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.

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 4 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.