Dr Keith Dineen Wagner, MD - Medicare Dermatology in Appleton, WI

Dr Keith Dineen Wagner, MD is a medicare enrolled "Dermatology" physician in Appleton, Wisconsin. His current practice location is 3935 N Lightning Dr, Appleton, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (920) 968-1790.

Dr Keith Dineen Wagner is licensed to practice in Wisconsin (license number 82425-20) 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 1760047112.

Contact Information

Dr Keith Dineen Wagner, MD
3935 N Lightning Dr,
Appleton, WI 54913-6717
(920) 968-1790
(920) 968-1794

Map and Direction




Physician's Profile

Full NameDr Keith Dineen Wagner
GenderMale
SpecialityDermatology
Location3935 N Lightning Dr, Appleton, Wisconsin
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1760047112
  • Provider Enumeration Date: 05/01/2019
  • Last Update Date: 09/11/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 3971965567
  • Enrollment ID: I20230814003291

Medical Identifiers

Medical identifiers for Dr Keith Dineen Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1760047112NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207N00000XDermatology 82425-20 (Wisconsin)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 Keith Dineen Wagner allows following entities to bill medicare on his behalf.
Entity NameForefront Dermatology Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1083768253
PECOS PAC ID: 3779471701
Enrollment ID: O20040310000252

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 Keith Dineen 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 AddressPractice Location Address
Dr Keith Dineen Wagner, MD
801 York St,
Manitowoc, WI 54220-4630

Ph: (920) 663-9008
Dr Keith Dineen Wagner, MD
3935 N Lightning Dr,
Appleton, WI 54913-6717

Ph: (920) 968-1790

Reviews and Comments


Dermatology Doctors in Appleton, WI

Brent Robert Weed, M.D.
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 3935 N. Lightning Drive, Appleton, WI 54913
Phone: 920-968-1790    Fax: 920-686-9674
Dr. Charles Norman Kagen, M.D.
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 100 W Lawrence St, Suite 409, Appleton, WI 54911
Phone: 920-733-5138    Fax: 920-733-3759
Dr. Peter J Katz, MD
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 3935 N Lightning Dr, Appleton, WI 54913
Phone: 920-968-1790    Fax: 920-968-1794
Michelle D Lewis, MD
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 3935 N. Lightning Drive, Appleton, WI 54913
Phone: 920-968-1790    Fax: 920-968-1794
Dr. John William Faber, M.D.
Dermatology
Medicare: Not Enrolled in Medicare
Practice Location: 412 E Longview Dr., Appleton, WI 54911
Phone: 920-734-6880    Fax: 920-734-8867
Noah Robert Smith, MD
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 3935 N Lightning Dr, Appleton, WI 54913
Phone: 920-968-1790    Fax: 920-968-1794

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.