Dr Kelly E Van Wagner, MD is a medicare enrolled "Internal Medicine" physician in N. Las Vegas, Nevada. She graduated from medical school in 1997 and has 27 years of diverse experience with area of expertise as Internal Medicine. She is a member of the group practice Intermountain Medical Holdings Nevada Inc and her current practice location is
6380 N. Decatur Blvd, Ste 215, N. Las Vegas, Nevada. You can reach out to her office (for appointments etc.) via phone at
(702) 948-1145.
Dr Kelly E Van Wagner is licensed to practice in Nevada (license number 9533) 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 1306035571.
Physician's Profile
| Full Name | Dr Kelly E Van Wagner |
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| Gender | Female |
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| Speciality | Internal Medicine |
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| Experience | 27 Years |
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| Location | 6380 N. Decatur Blvd, N. Las Vegas, Nevada |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Kelly E Van Wagner graduated from medical school in 1997
NPI Data:
- NPI Number: 1306035571
- Provider Enumeration Date: 10/23/2007
- Last Update Date: 02/13/2023
Medicare PECOS Information:
- PECOS PAC ID: 9537113543
- Enrollment ID: I20050311000240
Medical Identifiers
Medical identifiers for Dr Kelly E Van Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1306035571 | NPI | - | NPPES |
| 9533 | Other | NV | STATE LICENSE |
| V114112 | Other | NV | SMA MEDICARE |
| 1306035571 | Medicaid | NV | |
| 1306035571 | Other | NV | SMA MEDICAID |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | 9533 (Nevada) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Intermountain Medical Holdings Nevada Inc | 7416054622 | 286 |
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 Kelly E Van Wagner allows following entities to bill medicare on her behalf.
| Entity Name | Healthcare Partners Medical Group Coats Ltd |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1487631917
PECOS PAC ID: 5991866303
Enrollment ID: O20100113000898 |
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| Entity Name | Intermountain Medical Holdings Nevada Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1245997279
PECOS PAC ID: 7416054622
Enrollment ID: O20220214001765 |
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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 Kelly E Van 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 |
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Dr Kelly E Van Wagner, MD
6355 S Buffalo Dr Fl 3,
Las Vegas, NV 89113-2133
Ph: (702) 216-3346 | Dr Kelly E Van Wagner, MD
6380 N. Decatur Blvd, Ste 215,
N. Las Vegas, NV 89084
Ph: (702) 948-1145 |
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