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JASON FREDRICK WAGNER APRN, LMHC, MCAP
NPI 1720536691
Nurse Practitioner - Psychiatric/Mental Health in Hollywood, FL

Active since September 20, 2016PECOS EnrolledAccepts Medicare Assignment
111 W CORAL WAY, HOLLYWOOD, FL 33021(954) 964-6338(954) 965-1327 Get Directions Write a Review

NPPES record last updated: May 1, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 1, 2024, Aug 11, 2022, Nov 16, 2019 and 3 more (6 updates tracked since 2016).

About Jason Fredrick Wagner Aprn, Lmhc, Mcap NPPES

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

JASON FREDRICK WAGNER APRN, LMHC, MCAP (NPI 1720536691) is an individual psychiatric/mental health provider in Hollywood, Florida, licensed in Florida (APRN11004343) and active in the NPI registry since September 2016. He is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1720536691
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameJASON FREDRICK WAGNERCredential: APRN, LMHC, MCAP
Location Address111 W CORAL WAYHollywood, FL 33021-3860
Mailing Address135 Weston Rd # 236Weston, FL 33326-1111 · (954) 483-5455
Phone(954) 964-6338
Fax(954) 965-1327
Sole ProprietorYes
Medical School CMSOtherGraduated 2019
Enumeration DateSeptember 20, 2016
Last NPPES UpdateMay 1, 20246 updates tracked since enumeration
NPPES CertifiedMay 1, 2024
✔ NPI 1720536691 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in FL · APRN11004343
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License MH8961 (FL)
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License MH8961 (FL)
111 W CORAL WAY, Hollywood, FL 33021
Open in Google Maps ↗

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

Jason Fredrick Wagner Aprn, Lmhc, Mcap 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 ID2668806159
PECOS Enrollment IDI20250421002841
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Jason Wagner reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Seminole Tribe Of Florida Health Dept.
0.5 mi
Primary Care
3006 JOSIE BILLIE AVE
Hollywood, FL 33024
  • Reassigned Medicare billing, Texas enrollment
  • Medicare enrollment name: Seminole Tribe Of Florida
  • 14 clinicians in this Medicare group
NPI 1144551748 (954) 962-2009
David Lawrence Mental Health Center, Inc
95 mi
Community/Behavioral Health
6075 BATHEY LN
Naples, FL 34116
  • Reassigned Medicare billing, Florida enrollment
  • 90 clinicians in this Medicare group
NPI 1801891940 (239) 455-8500

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 33021 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
$91.69 typical visit price
range $58.56 – $179.05
Typical copayment $22.92 (range $14.64 – $44.76)
Most-billed visit code 99203
Established Patient
$103.21 typical visit price
range $18.44 – $144.68
Typical copayment $25.80 (range $4.61 – $36.17)
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 4

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

KYNAN METOYER PSY.D.
Clinical Neuropsychologist
111 W CORAL WAY
HOLLYWOOD, FL 33021
Broward County (808) 298-3640
DR. KAVITA KATRINA MARAJH PSY.D.
Psychologist (Clinical)
111 W CORAL WAY
HOLLYWOOD, FL 33021
Broward County (954) 964-6338
SARA PHUONG THIHA HOANG APRN
Nurse Practitioner (Family)
111 W CORAL WAY
HOLLYWOOD, FL 33021
Broward County (954) 962-2009
CASSANDRA CALCAGNO
Counselor (Addiction (Substance Use Disorder))
111 W CORAL WAY
HOLLYWOOD, FL 33021
Broward County (954) 237-9604

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 Jason Wagner's NPI number?

The NPI number for Jason Wagner is 1720536691. It was assigned to this individual provider in the NPPES registry on September 20, 2016.

Where is Jason Wagner located?

Jason Wagner practices at 111 W Coral Way, Hollywood, FL 33021. The listed phone number is (954) 964-6338.

What is Jason Wagner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jason Wagner enrolled in Medicare?

Yes. Jason 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 organizations bill Medicare for Jason Wagner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jason Wagner reassigns Medicare benefits to 2 organizations: Seminole Tribe Of Florida Health Dept. (Hollywood, FL) and David Lawrence Mental Health Center, Inc (Naples, FL). Each 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 Jason Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jason Wagner was last updated on May 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.