JACK WAGONER M.D.
NPI 1518979665
Surgery in Sycamore, IL

Q: What is Jack Wagoner's NPI number?

The NPI number for Jack Wagoner is 1518979665. It was assigned to this individual provider in the NPPES registry on August 13, 2006.

Q: What is Jack Wagoner's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Wagoner was last updated on June 11, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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 13, 2006PECOS EnrolledAccepts Medicare Assignment

94.1/100

CMS Quality Rating

1850 GATEWAY DR, SYCAMORE, IL 60178(815) 758-8671(815) 758-5610 Get Directions Write a Review

NPPES record last updated: June 11, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Jack Wagoner M.d. NPPES

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

JACK WAGONER M.D. (NPI 1518979665) is an individual surgery provider in Sycamore, Illinois, licensed in Illinois (036-100314) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Northwestern Medicine Central Dupage Hospital, and is a graduate of Southern Illinois University School Of Medicine (1993).

NPPES Registry Identity

NPI1518979665

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameJACK WAGONERCredential: M.D.

Location Address1850 GATEWAY DRSycamore, IL 60178-3192

Mailing Address1850 Gateway DrSycamore, IL 60178-3192 · (815) 758-8671 · Fax (815) 758-5610

Phone(815) 758-8671

Fax(815) 758-5610

Sole ProprietorNo

Medical School CMSSouthern Illinois University School Of MedicineGraduated 1993

Enumeration DateAugust 13, 2006

Last NPPES UpdateJune 11, 2012

✔ NPI 1518979665 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in IL · 036-100314

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

1850 GATEWAY DR, Sycamore, IL 60178

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Other Identifiers 4

Other048118IL · Health Alliance

Medicare UPINH04606IL

Medicare ID-Type Unspecified557930IL

Medicaid036100314IL

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

Jack Wagoner M.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 ID8527964824

PECOS Enrollment IDI20101201000246

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.

Areas of Expertise CMS Part B claims 14

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

85 services41 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

78 services25 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

47 services41 patients

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

43 services43 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

41 services41 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

30 services28 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

25 services25 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

24 services24 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

18 services18 patients

Removal of gallbladder using an endoscope 47562

This procedure, known as endoscopic gallbladder removal, involves a surgeon using a special tool called an endoscope to remove your gallbladder through small incisions. It's typically done to treat gallstones and related complications. It's a less invasive method, often leading to quicker recovery.

16 services16 patients

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

16 services16 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

16 services16 patients

Fine needle aspiration biopsy using ultrasound guidance, first growth 10005

Fine needle aspiration biopsy with ultrasound guidance is a procedure where a thin needle is inserted into a growth to extract a small sample. Ultrasound helps accurately locate the growth. This sample is then analyzed to determine the nature of the growth.

15 services15 patients

Repair of groin hernia using an endoscope 49650

This procedure involves the use of an endoscope, a thin tube with a camera, to repair a hernia in the groin area. The surgeon makes small incisions, inserts the endoscope, and uses special tools to fix the hernia. This minimally invasive technique often results in quicker recovery times.

14 services14 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northwestern Medicine Central Dupage Hospital

Acute Care Hospitals · Winfield, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140242

Location25 North Winfield RoadWinfield, IL 60190 · Du Page County

Emergency services Birthing friendly

Northwestern Medicine Kishwaukee Hospital

Acute Care Hospitals · Dekalb, IL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140286

LocationOne Kish Hospital DriveDekalb, IL 60115 · De Kalb County

Emergency services Birthing friendly

Valley West Community Hospital

Critical Access Hospitals · Sandwich, IL

OwnershipVoluntary non-profit - Private

CMS Certification Number141340

Location1301 North Main StreetSandwich, IL 60548 · De Kalb County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60178 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

94.1/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

82.59

Promoting Interoperability

100

Improvement Activities

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.

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