| Jessica Wagner, PA-C | |
|
1296 Jeffco Blvd, Arnold, MO 63010-2138 | |
| (636) 321-8610 | |
| Not Available |
| Full Name | Jessica Wagner |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 8 Years |
| Location | 1296 Jeffco Blvd, Arnold, Missouri |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649837246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 2019009367 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Mercy Hospital Joplin | Joplin, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mercy Aco Clinical Services Inc | 6901188572 | 159 |
| County Of St Louis Division Of Fiscal Management | 0941285720 | 15 |
| Entity Name | SSM Health Care St Louis |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275586174 PECOS PAC ID: 7810800737 Enrollment ID: O20031118000393 |
| Entity Name | County of St Louis Division of Fiscal Management |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780639088 PECOS PAC ID: 0941285720 Enrollment ID: O20040628000772 |
| Entity Name | Mercy Aco Clinical Services Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063965093 PECOS PAC ID: 6901188572 Enrollment ID: O20170117001888 |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Wagner, PA-C 219 Stillbrook Estates Dr, Fenton, MO 63026-6505 Ph: Not Available | Jessica Wagner, PA-C 1296 Jeffco Blvd, Arnold, MO 63010-2138 Ph: (636) 321-8610 |
Richard Donnell, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 3619 Richardson Square Dr, Arnold, MO 63010 Phone: 314-434-8174 Fax: 636-464-6755 |