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DR. KELLY E VAN WAGNER M.D.
NPI 1306035571
Internal Medicine in N. Las Vegas, NV

Active since October 23, 2007PECOS Enrolled
6380 N. DECATUR BLVD, STE 215, N. LAS VEGAS, NV 89084(702) 948-1145(702) 949-6206 Get Directions Write a Review

NPPES record last updated: February 13, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Feb 13, 2023, Oct 21, 2022, Jun 11, 2019 and 3 more (6 updates tracked since 2016).

About Dr. Kelly E Van Wagner M.d. NPPES

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

DR. KELLY E VAN WAGNER M.D. (NPI 1306035571) is an individual internal medicine provider in N. Las Vegas, Nevada, licensed in Nevada (9533) and active in the NPI registry since October 2007. She is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1306035571
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. KELLY E VAN WAGNERCredential: M.D.
Location Address6380 N. DECATUR BLVD, STE 215N. Las Vegas, NV 89084
Mailing Address6355 S Buffalo Dr Fl 3Las Vegas, NV 89113-2133 · (702) 216-3346 · Fax (702) 671-6883
Phone(702) 948-1145
Fax(702) 949-6206
Sole ProprietorYes
Enumeration DateOctober 23, 2007
Last NPPES UpdateFebruary 13, 20236 updates tracked since enumeration
NPPES CertifiedFebruary 6, 2023
✔ NPI 1306035571 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NV · 9533
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
6380 N. DECATUR BLVD, N. Las Vegas, NV 89084
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Secondary Practice Locations 3

Location 11380 European DrHenderson, NV 89052-4020 · Phone (702) 419-3535
Location 26355 S Buffalo Dr Fl 3Las Vegas, NV 89113-2133 · Phone (702) 216-3346 · Fax (702) 671-6883
Location 35230 Boulder Hwy Ste 110Las Vegas, NV 89122-6077 · Phone (702) 940-1560 · Fax (702) 940-1561

Other Identifiers 4

Other9533NV · State License
OtherV114112NV · Sma Medicare
Medicaid1306035571NV
Other1306035571NV · Sma Medicaid

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelly E Van Wagner M.d. 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 89084 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
$131.25 typical visit price
range $57.07 – $173.24
Typical copayment $32.81 (range $14.26 – $43.31)
Most-billed visit code 99204
Established Patient
$100.60 typical visit price
range $18.27 – $140.96
Typical copayment $25.15 (range $4.56 – $35.24)
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.

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 Kelly Van Wagner's NPI number?

The NPI number for Kelly Van Wagner is 1306035571. It was assigned to this individual provider in the NPPES registry on October 23, 2007.

Where is Kelly Van Wagner located?

Kelly Van Wagner practices at 6380 N. Decatur Blvd Ste 215, N. Las Vegas, NV 89084. The listed phone number is (702) 948-1145.

What is Kelly Van Wagner's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kelly Van Wagner enrolled in Medicare?

Yes. Kelly Van Wagner is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Van Wagner was last updated on February 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.