Dr Derek Lamont Wagner, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Nashville, Tennessee. His current practice location is
1005 Dr Db Todd Jr Blvd, Nashville, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(615) 327-6385.
Dr Derek Lamont Wagner is licensed to practice in Tennessee (license number ) 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 1659012169.
Physician's Profile
| Full Name | Dr Derek Lamont Wagner |
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| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 1005 Dr Db Todd Jr Blvd, Nashville, Tennessee |
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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: 1659012169
- Provider Enumeration Date: 04/06/2022
- Last Update Date: 03/30/2026
Medicare PECOS Information:
- PECOS PAC ID: 2062891450
- Enrollment ID: I20250318003688
Medical Identifiers
Medical identifiers for Dr Derek Lamont Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1659012169 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 208D00000X | General Practice | 4301512090 (Michigan) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (Tennessee) | 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 Derek Lamont Wagner allows following entities to bill medicare on his behalf.
| Entity Name | Signify Health Medical Associates Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1750845863 PECOS PAC ID: 2163764424 Enrollment ID: O20210405000855 |
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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 Derek Lamont 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 Derek Lamont Wagner, MD 1562 Crestview Dr Apt 306, Madison, TN 37115-2195 Ph: (336) 407-5982 | Dr Derek Lamont Wagner, MD 1005 Dr Db Todd Jr Blvd, Nashville, TN 37208-3501 Ph: (615) 327-6385 |
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