Jacquelynn Wagoner, DO in Fresno, CA

Jacquelynn Wagoner, DO is a medicare enrolled "Pediatrics" physician in Fresno, California. Her current practice location is 2823 Fresno St, Fresno, California. You can reach out to her office (for appointments etc.) via phone at (559) 499-6556.

Jacquelynn Wagoner is licensed to practice in California (license number 20A15405) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1184011074.

Contact Information

	Jacquelynn Wagoner, DO
	2823 Fresno St, Fresno, CA 93721-1324
	(559) 499-6556
	Not Available

Map and Direction

Physician's Profile

Full Name	Jacquelynn Wagoner
Gender	Female
Speciality	Pediatrics
Location	2823 Fresno St, Fresno, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1184011074
Provider Enumeration Date: 04/19/2015
Last Update Date: 01/10/2020

Medicare PECOS Information:

PECOS PAC ID: 7416201595
Enrollment ID: I20181107002747

Medical Identifiers

Medical identifiers for Jacquelynn Wagoner such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1184011074	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	20A15405 (California)	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. Jacquelynn Wagoner allows following entities to bill medicare on her behalf.

Entity Name	Community Foundation Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1811258510 PECOS PAC ID: 0345406294 Enrollment ID: O20120723000387

Entity Name	University Faculty Associates Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073911137 PECOS PAC ID: 6507181708 Enrollment ID: O20150211000164

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. Jacquelynn Wagoner 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
Jacquelynn Wagoner, DO 2625 E Divisadero St, Fresno, CA 93721-1431 Ph: (559) 443-2682	Jacquelynn Wagoner, DO 2823 Fresno St, Fresno, CA 93721-1324 Ph: (559) 499-6556

Reviews and Comments

Pediatrics Doctors in Fresno, CA

Wilfred Derksen, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1570 E Herndon Ave, Fresno, CA 93720 Phone: 559-437-7300 Fax: 559-437-7153
Dr. Jean Rankin Butterfield, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2719 N Air Fresno Dr, Fresno, CA 93727 Phone: 559-600-8918
Dr. Mary A Gonzalez-howard, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 4770 W Herndon Ave, Suite 108, Fresno, CA 93722 Phone: 559-256-7990 Fax: 559-256-7991
Nilufer Raj Goyal-shockley, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 7300 N Fresno St, Fresno, CA 93720 Phone: 559-448-4500
Dr. Nitika Narinder Dhir, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 155 N Fresno St, Ste 326, Fresno, CA 93701 Phone: 559-499-6466
Denise Der Knudson, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 4785 N 1st St, Fresno, CA 93726 Phone: 559-448-4894
Reem Aboushaar, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2823 Fresno St, Fresno, CA 93721 Phone: 559-443-2682 Fax: 559-443-2681

Jacquelynn Wagoner, DO - Medicare Pediatrics in Fresno, CA