Dr Keith Dineen Wagner, MD in Appleton, WI

Dr Keith Dineen Wagner, MD is a medicare enrolled "Dermatology" physician in Appleton, Wisconsin. His current practice location is 3935 N Lightning Dr, Appleton, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (920) 968-1790.

Dr Keith Dineen Wagner is licensed to practice in Wisconsin (license number 82425-20) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1760047112.

Contact Information

	Dr Keith Dineen Wagner, MD
	3935 N Lightning Dr, Appleton, WI 54913-6717
	(920) 968-1790
	(920) 968-1794

Map and Direction

Physician's Profile

Full Name	Dr Keith Dineen Wagner
Gender	Male
Speciality	Dermatology
Location	3935 N Lightning Dr, Appleton, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1760047112
Provider Enumeration Date: 05/01/2019
Last Update Date: 09/11/2023

Medicare PECOS Information:

PECOS PAC ID: 3971965567
Enrollment ID: I20230814003291

Medical Identifiers

Medical identifiers for Dr Keith Dineen Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1760047112	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207N00000X	Dermatology	82425-20 (Wisconsin)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Keith Dineen Wagner allows following entities to bill medicare on his behalf.

Entity Name	Forefront Dermatology Sc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1083768253 PECOS PAC ID: 3779471701 Enrollment ID: O20040310000252

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Keith Dineen Wagner is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Keith Dineen Wagner, MD 801 York St, Manitowoc, WI 54220-4630 Ph: (920) 663-9008	Dr Keith Dineen Wagner, MD 3935 N Lightning Dr, Appleton, WI 54913-6717 Ph: (920) 968-1790

Reviews and Comments

Dermatology Doctors in Appleton, WI

Brent Robert Weed, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3935 N. Lightning Drive, Appleton, WI 54913 Phone: 920-968-1790 Fax: 920-686-9674
Dr. Charles Norman Kagen, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 100 W Lawrence St, Suite 409, Appleton, WI 54911 Phone: 920-733-5138 Fax: 920-733-3759
Dr. Peter J Katz, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3935 N Lightning Dr, Appleton, WI 54913 Phone: 920-968-1790 Fax: 920-968-1794
Michelle D Lewis, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3935 N. Lightning Drive, Appleton, WI 54913 Phone: 920-968-1790 Fax: 920-968-1794
Dr. John William Faber, M.D. Dermatology Medicare: Not Enrolled in Medicare Practice Location: 412 E Longview Dr., Appleton, WI 54911 Phone: 920-734-6880 Fax: 920-734-8867
Noah Robert Smith, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 3935 N Lightning Dr, Appleton, WI 54913 Phone: 920-968-1790 Fax: 920-968-1794

Dr Keith Dineen Wagner, MD - Medicare Dermatology in Appleton, WI