JACKLYN MARIE WAGNER PT, DPT, ATC
NPI 1659745073
Physical Therapist in South Portland, ME
About Jacklyn Marie Wagner Pt, Dpt, Atc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKLYN MARIE WAGNER PT, DPT, ATC (NPI 1659745073) is an individual physical therapist in South Portland, Maine, licensed in Maine (PT5423) and active in the NPI registry since November 2015. She maintains a secondary practice location in Yarmouth and is a graduate of Other (2015).
NPPES Registry Identity
Specialties & Licenses
- Diagnose and manage movement dysfunction and enhance physical and functional abilities.
- Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
- Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
- Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
- Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Other Names 1
Secondary Practice Location 1
Accepted Insurance
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
Jacklyn Marie Wagner Pt, Dpt, Atc 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 Reassignment
Medicare enrollment records show Jacklyn Wagner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
South Portland, ME 04106
- Reassigned Medicare billing, Maine enrollment
- 200 clinicians in this Medicare group
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 04106 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 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Jacklyn Wagner's NPI number?
The NPI number for Jacklyn Wagner is 1659745073. It was assigned to this individual provider in the NPPES registry on November 23, 2015. The provider is also known as Jacklyn Marie Boss Pt, Dpt, Atc.
Where is Jacklyn Wagner located?
Jacklyn Wagner practices at 50 Foden Road Suite C, South Portland, ME 04106. The listed phone number is (207) 780-8860.
What is Jacklyn Wagner's specialty?
The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.
Is Jacklyn Wagner enrolled in Medicare?
Yes. Jacklyn 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 organization bills Medicare for Jacklyn Wagner's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacklyn Wagner reassigns Medicare benefits to Intermed, PA (South Portland, ME). The 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 Jacklyn Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jacklyn Wagner accept?
Health plans from Anthem Blue Cross and Blue Shield list Jacklyn Wagner as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jacklyn Wagner was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.
# Jacklyn Marie Wagner, PT, DPT, ATC · NPI 1659745073
Physical Therapist provider in South Portland, Maine. Individual provider, active in the CMS NPPES registry since November 23, 2015.
## Identity
- **NPI:** 1659745073 (Entity type: Individual)
- **Enumerated:** November 23, 2015
- **Primary specialty:** Physical Therapist · taxonomy 225100000X
- **State license:** PT5423 (Maine)
- **Sole proprietor:** No
## Practice location
- **Address:** 50 FODEN ROAD, SUITE C, South Portland, ME 04106
- **Phone:** (207) 780-8860
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** Intermed, PA (NPI 1467422733, South Portland, ME), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2015
## Record status
- **NPPES last updated:** July 21, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1659745073) · Data from the CMS NPPES public registry.