DR. JEROME PETER WAGNER PH.D.
NPI 1487664850
Psychologist - Clinical in Evanston, IL

Q: What is Jerome Wagner's NPI number?

The NPI number for Jerome Wagner is 1487664850. It was assigned to this individual provider in the NPPES registry on August 9, 2006.

Q: What is Jerome Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Jerome Wagner was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.

Active since August 09, 2006PECOS EnrolledAccepts Medicare Assignment

2603 BROADWAY AVE, EVANSTON, IL 60201(847) 492-1690 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Dr. Jerome Peter Wagner Ph.d. NPPES

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

DR. JEROME PETER WAGNER PH.D. (NPI 1487664850) is an individual clinical provider in Evanston, Illinois and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS and is a graduate of Loyola University Of Chicago, Stritch School Of Medicine (1981).

NPPES Registry Identity

NPI1487664850

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. JEROME PETER WAGNERCredential: PH.D.

Location Address2603 BROADWAY AVEEvanston, IL 60201-1501

Mailing Address2603 Broadway AveEvanston, IL 60201-1501

Phone(847) 492-1690

Sole ProprietorYes

Medical School CMSLoyola University Of Chicago, Stritch School Of MedicineGraduated 1981

Enumeration DateAugust 9, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1487664850 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

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.

2603 BROADWAY AVE, Evanston, IL 60201

Open in Google Maps ↗

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

Dr. Jerome Peter Wagner Ph.d. 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 ID5698951424

PECOS Enrollment IDI20110512000398

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 60201 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

$183.39 typical visit price

range $60.08 – $183.39

Typical copayment $45.84 (range $15.02 – $45.84)

Most-billed visit code 99205

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

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 3

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

DR. DANIEL FRANCIS BARNES PH.D.

Psychologist (Clinical)

2603 BROADWAY AVE
EVANSTON, IL 60201

Cook County (847) 491-9337

DR. KARIN A RUETZEL

Psychologist (Clinical)

2603 BROADWAY AVE, 2ND FLOOR
EVANSTON, IL 60201

Cook County (847) 866-7949

PSYCHIATRIC WELLNESS SUITE PLLC

Nurse Practitioner (Psychiatric/Mental Health)

2603 BROADWAY AVE
EVANSTON, IL 60201

Cook County (847) 961-2293

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 Jerome Wagner's NPI number?

The NPI number for Jerome Wagner is 1487664850. It was assigned to this individual provider in the NPPES registry on August 9, 2006.

Where is Jerome Wagner located?

Jerome Wagner practices at 2603 Broadway Ave, Evanston, IL 60201. The listed phone number is (847) 492-1690.

What is Jerome Wagner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jerome Wagner enrolled in Medicare?

Yes. Jerome 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 Jerome Wagner was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.