| Ms Ellen A Wagner, CRNA | |
|
265 Herrick Road, Southampton, NY 11968 | |
| (631) 726-8350 | |
| (631) 726-8519 |
| Full Name | Ms Ellen A Wagner |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 45 Years |
| Location | 265 Herrick Road, Southampton, New York |
| 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 |
|---|---|---|---|
| 1568408789 | NPI | - | NPPES |
| P00164249 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 3472891 (New York) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | APRN03496 (Rhode Island) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Our Lady Of Fatima Hospital | North providence, RI | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Narragansett Bay Anesthesia Llc | 5991774929 | 86 |
| Entity Name | Narragansett Bay Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1861445728 PECOS PAC ID: 5991774929 Enrollment ID: O20040928000003 |
| Entity Name | South County Anesthesia Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790193522 PECOS PAC ID: 2062735053 Enrollment ID: O20141224000069 |
| Entity Name | Anesthesia Partners Of New England Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326672312 PECOS PAC ID: 2365835428 Enrollment ID: O20220214000313 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Ellen A Wagner, CRNA 455 Toll Gate Rd, Prc And Credentialing, Warwick, RI 02886 Ph: (401) 273-0641 | Ms Ellen A Wagner, CRNA 265 Herrick Road, Southampton, NY 11968 Ph: (631) 726-8350 |
Mr. Robert Mineo, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 265 Herrick Road, Southampton, NY 11968 Phone: 631-726-8350 Fax: 631-726-8519 | |
Catherine Anne Ruggiero, DNP, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 240 Meeting House Ln, Southampton, NY 11968 Phone: 631-726-8200 |