MATTHEW WAGNER M.D. - NPI 1790166445 - Family Medicine in Maumelle, AR

Q: What is Matthew Wagner's NPI number?

The NPI number for Matthew Wagner is 1790166445. It was assigned to this individual provider in the NPPES registry on June 17, 2015.

Q: What is Matthew Wagner's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: Is Matthew Wagner enrolled in Medicare?

No. Matthew Wagner has opted out of Medicare through May 21, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Matthew Wagner was last updated on September 4, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Matthew Wagner M.d. NPPES

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

MATTHEW WAGNER M.D. (NPI 1790166445) is an individual family medicine provider in Maumelle, Arkansas, licensed in Arkansas (E-11361) and active in the NPI registry since June 2015. He has opted out of Medicare through May 21, 2027 and remains eligible to order and refer and maintains a secondary practice location in Wichita.

NPPES Registry Identity

NPI1790166445

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameMATTHEW WAGNERCredential: M.D.

Location Address1701 CLUB MANOR DR STE 2BMaumelle, AR 72113

Mailing Address1701 Club Manor Dr Ste 2bMaumelle, AR 72113-7401 · (501) 812-7216

Phone(501) 812-7216

Sole ProprietorYes

Enumeration DateJune 17, 2015

Last NPPES UpdateSeptember 4, 2018

✔ NPI 1790166445 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in AR · E-11361

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1701 CLUB MANOR DR STE 2B, Maumelle, AR 72113

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Secondary Practice Location 1

Location 11010 N Kansas StWichita, KS 67214-3124 · Phone (316) 293-2665

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Matthew Wagner M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 21, 2025 through May 21, 2027.

Opt-Out Effective DateMay 21, 2025

Opt-Out In Effect ThroughMay 21, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72113 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

$79.72 typical visit price

range $51.36 – $157.74

Typical copayment $19.93 (range $12.84 – $39.43)

Most-billed visit code 99203

Established Patient

$91.63 typical visit price

range $16.16 – $128.77

Typical copayment $22.90 (range $4.04 – $32.19)

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.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier33 claims33 services$20.02 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

1 supplier12 claims12 services$900.57 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers34 claims34 services$112.42 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 8

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

RYAN A COLEMAN

Internal Medicine