Diane Wagner, in Fairfax, VA - Medicare Clinical Psychologist Provider

Diane Wagner, is a medicare enrolled "Psychologist - Clinical" provider in Fairfax, Virginia. She graduated from medical school in 2017 and has 7 years of diverse experience with area of expertise as Clinical Psychologist. Her current practice location is 11325 Random Hills Rd Ste 360, Fairfax, Virginia. You can reach out to her office (for appointments etc.) via phone at (703) 646-1518.

Diane Wagner is licensed to practice in Virginia (license number 0810006006) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1194211540.

Contact Information

	Diane Wagner,
	11325 Random Hills Rd Ste 360, Fairfax, VA 22030-0972
	(703) 646-1518
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Diane Wagner
Gender	Female
Speciality	Clinical Psychologist
Experience	7 Years
Location	11325 Random Hills Rd Ste 360, Fairfax, Virginia
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Diane Wagner graduated from medical school in 2017

NPI Data:

NPI Number: 1194211540
Provider Enumeration Date: 07/09/2018
Last Update Date: 08/27/2021

Medicare PECOS Information:

PECOS PAC ID: 9830448844
Enrollment ID: I20180824001661

Medical Identifiers

Medical identifiers for Diane Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1194211540	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TC0700X	Psychologist - Clinical	0810006006 (Virginia)	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. Diane Wagner allows following entities to bill medicare on her behalf.

Entity Name	Clinical Psychology Services Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1194818054 PECOS PAC ID: 5496718793 Enrollment ID: O20041108000889

Entity Name	Wagner Psychotherapy Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1962179804 PECOS PAC ID: 0749686871 Enrollment ID: O20210914003914

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. Diane 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
Diane Wagner, 10911 Adare Dr, Fairfax, VA 22032-3105 Ph: (703) 646-1518	Diane Wagner, 11325 Random Hills Rd Ste 360, Fairfax, VA 22030-0972 Ph: (703) 646-1518

Reviews and Comments

Psychologist in Fairfax, VA

Katherine Nethercote, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8270 Willow Oaks Corporate Dr, Fairfax, VA 22031 Phone: 571-423-4900
Adrienne Konstantin, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3925 Blenheim Blvd Ste 53a, Fairfax, VA 22030 Phone: 703-972-2388
Dr. Jennie Lynn Crim, PSYD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 10560 Main St Ste 507, Fairfax, VA 22030 Phone: 703-691-1326 Fax: 703-691-3553
Dr. Diane Marie Hoekstra, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 10721 Main St Ste 2350, Fairfax, VA 22030 Phone: 703-591-5912 Fax: 703-581-7210
Frances Jillian Priesmeyer, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8270 Willow Oaks Corporate Dr, Fairfax, VA 22031 Phone: 703-619-4859
Kathleen Racz Baker, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8270 Willow Oaks Corporate Dr, Fairfax, VA 22031 Phone: 703-899-4061
Jennie Song, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 8270 Willow Oaks Corporate Dr, Fairfax, VA 22031 Phone: 571-423-4250

Diane Wagner, - Medicare Psychologist in Fairfax, VA