Dr Matthew Robert Wagner, MD is a medicare enrolled "Orthopaedic Surgery - Pediatric Orthopaedic Surgery" physician in Port Jefferson Station, New York. His current practice location is
1500 Route 112 Bldg 2c, Port Jefferson Station, New York. You can reach out to his office (for appointments etc.) via phone at
(631) 371-8034.
Dr Matthew Robert Wagner is licensed to practice in New York (license number 251727) 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 1114198751.
Physician's Profile
Full Name | Dr Matthew Robert Wagner |
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Gender | Male |
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Speciality | Orthopaedic Surgery - Pediatric Orthopaedic Surgery |
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Location | 1500 Route 112 Bldg 2c, Port Jefferson Station, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1114198751
- Provider Enumeration Date: 03/21/2008
- Last Update Date: 11/05/2019
Medicare PECOS Information:
- PECOS PAC ID: 2860630498
- Enrollment ID: I20130521000407
Medical Identifiers
Medical identifiers for Dr Matthew Robert Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1114198751 | NPI | - | NPPES |
120130521000407 | Other | NY | MEDICARE |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207XP3100X | Orthopaedic Surgery - Pediatric Orthopaedic Surgery | ME103612 (Florida) | Secondary |
207XP3100X | Orthopaedic Surgery - Pediatric Orthopaedic Surgery | 251727 (New York) | 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 Matthew Robert Wagner allows following entities to bill medicare on his behalf.
Entity Name | Orthopedic Associates Of Long Island Llp |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1194823914 PECOS PAC ID: 4880592419 Enrollment ID: O20031222000067 |
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Entity Name | Chs Physician Partners Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1164585725 PECOS PAC ID: 7618955667 Enrollment ID: O20040708000027 |
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Entity Name | St Charles Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1497765630 PECOS PAC ID: 6103733050 Enrollment ID: O20050205000015 |
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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 Matthew Robert 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 Matthew Robert Wagner, MD 1500 Route 112 Bldg 2c, Port Jefferson Station, NY 11776-8055 Ph: (631) 371-8034 | Dr Matthew Robert Wagner, MD 1500 Route 112 Bldg 2c, Port Jefferson Station, NY 11776-8055 Ph: (631) 371-8034 |
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