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DR. DERRICK DURELL WAGONER D.O. NPI 1760829220


NPI Information

NPI: 1760829220
Provider Name: DR. DERRICK DURELL WAGONER, D.O.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
1800 RENAISSANCE BLVD STE 110
EDMOND, OK
ZIP 73013
Phone: (405) 601-2325
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DR. Derrick Durell Wagoner, D.O. is a diagnostic radiology radiology in Edmond, OK with 11 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Derrick Durell Wagoner, D.O. NPI is 1760829220. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
Graduation Year:2013

The provider's business location address is:

1800 RENAISSANCE BLVD STE 110
EDMOND, OK
ZIP 73013
Phone: (405) 601-2325

The NPI 1760829220 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Injection of substance into spinal canal of lower back or sacrum using imaging guidance (HCPCS:62323)
  • Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
  • Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64493)
  • Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64494)
  • Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • Injection procedure into sacroiliac joint for anesthetic or steroid (HCPCS:27096)
  • Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (HCPCS:64483)
  • Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes (HCPCS:99152)
  • Injection, dexamethasone sodium phosphate, 1 mg (HCPCS:J1100)
  • Moderate sedation services by physician also performing a procedure, additional 15 minutes (HCPCS:99153)

The enumeration date for this NPI number is 5/23/2013 and was last updated on 8/31/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12085R0202XRadiologyDiagnostic Radiology6324OKLAHOMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200769850AMEDICAIDOKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.