DR. JACKSON WAGONER MD
NPI 1689137408
Anesthesiology - Pain Medicine in Casper, WY

Q: What is Jackson Wagoner's NPI number?

The NPI number for Jackson Wagoner is 1689137408. It was assigned to this individual provider in the NPPES registry on April 9, 2019.

Q: What is Jackson Wagoner's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pain Medicine, with taxonomy code 207LP2900X.

Q: When was this NPI record last updated?

The NPPES record for Jackson Wagoner was last updated on April 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since April 09, 2019PECOS EnrolledAccepts Medicare Assignment

97.64/100

CMS Quality Rating

1541 DIAMOND DR, CASPER, WY 82601(307) 439-1097 Get Directions Write a Review

NPPES record last updated: April 8, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 8, 2026, Mar 24, 2026, Mar 13, 2026 and 3 more (6 updates tracked since 2019).

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About Dr. Jackson Wagoner Md NPPES

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

DR. JACKSON WAGONER MD (NPI 1689137408) is an individual pain medicine provider in Casper, Wyoming, licensed in Wyoming (19414A) and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS, is affiliated with Uf Health Shands Hospital, and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1689137408

Entity TypeIndividualMale

Primary Taxonomy207LP2900X

Provider Legal NameDR. JACKSON WAGONERCredential: MD

Location Address1541 DIAMOND DRCasper, WY 82601-6247

Mailing AddressPo Box 100254Gainesville, FL 32610-0254 · (352) 273-8610 · Fax (352) 273-8612

Phone(307) 439-1097

Sole ProprietorNo

Medical School CMSNebraska College Of MedicineGraduated 2019

Enumeration DateApril 9, 2019

Last NPPES UpdateApril 8, 20266 updates tracked since enumeration

NPPES CertifiedApril 8, 2026

✔ NPI 1689137408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiology · Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207LP2900X

Licenses✔ Licensed in WY · 19414A✔ Licensed in FL · ME169309

Definition

An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.

Also ListedAnesthesiologyTaxonomy 207L00000X · License 69349 (AZ), ME169309 (FL)

1541 DIAMOND DR, Casper, WY 82601

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Secondary Practice Locations 3

Location 12600 Sixth St SWCanton, OH 44710-1702 · Phone (330) 452-9911

Location 21501 N Campbell Ave Rm 4401Tucson, AZ 85724-0001 · Phone (520) 626-7721

Location 31600 SW Archer RdGainesville, FL 32610-1702 · Phone (352) 273-8610 · Fax (352) 273-8612

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. Jackson Wagoner Md 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 ID6305269382

PECOS Enrollment IDI20240709004906, I20260219002020

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

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.

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.

15 services15 patients

Hospital Affiliations CMS Care Compare 4

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

Uf Health Shands Hospital

Acute Care Hospitals · Gainesville, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100113

Location1600 SW Archer RdGainesville, FL 32610 · Alachua County

Emergency services Birthing friendly

Sagewest Health Care

Acute Care Hospitals · Riverton, WY

1/5 CMS rating

OwnershipProprietary

CMS Certification Number530008

Location2100 W Sunset DrRiverton, WY 82501 · Fremont County

Emergency services

Summit Medical Center

Acute Care Hospitals · Casper, WY

OwnershipPhysician

CMS Certification Number530034

Location6350 E 2nd StreetCasper, WY 82609 · Natrona County

Memorial Hospital Of Converse County

Critical Access Hospitals · Douglas, WY

OwnershipGovernment - Local

CMS Certification Number531302

Location111 South 5th StreetDouglas, WY 82633 · Converse County

Emergency services Birthing friendly

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.

97.64/100

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

Scored through an Alternative Payment Model

Quality

84.77

Promoting Interoperability

98.67

Improvement Activities

Other Providers at the Same Location NPPES 12

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

HAND AND PHYSICAL THERAPY OF WYOMING LIMITED PARTNERSHIP

Durable Medical Equipment & Medical Supplies