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Deactivated NPI 1164532354 Deactivated / Inactive NPI Male Practitioner

Dr. Michael A. Wagner , MD

Ophthalmology • Rockford, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Michael Wagner has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 30, 2006
NPI Deactivation Date October 07, 2019
Total Practice Duration ~13 Years of Practice (2006 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Michael Wagner, MD was a registered Ophthalmology practicing in Rockford, IL. Throughout an active medical career spanning 13 years, Dr. Wagner provided care at the practice location at 2300 N ROCKTON AVE until profile deactivation on 2019-10-07.

Practice Location & Contact Primary Location

Practice Address

2300 N Rockton Ave

Rockford, IL 611033619

Telephone 8159712000
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Ophthalmology in Rockford, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 33.0 Yrs
State Avg: 31.1 Yrs
Regional Practice Density
15 Specialists

Practicing in Rockford, IL (954 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Ophthalmology Primary Specialty

NUCC Taxonomy Code: 207W00000X

State License IL 036-097924

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Prasad Kilaru , MD

Internal Medicine - Cardiovascular Disease

NPI 1003910423

Doctor of Medicine (M.D.)

Dr. David Mitchell , MD

Internal Medicine

NPI 1013027200

Doctor of Medicine (M.D.)

Jennifer Davidson , OT

Occupational Therapist

NPI 1013479575

Occupational Therapist

NPI 1033161435

Doctor of Medicine (M.D.)

Dr. Robin Hovis , MD

Internal Medicine - Rheumatology

NPI 1033229224

Doctor of Medicine (M.D.)

Mary Mather , CNM

Advanced Practice Midwife

NPI 1033262522

Certified Nurse Midwife

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 07, 2019

Record deactivated on October 07, 2019

NPI Profile Active January 26, 2010

NPI status registered as active in NPPES database

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Updated Practice Location January 26, 2010

Registered at 2300 N ROCKTON AVE, ROCKFORD, IL 611033619 (Tel: 8159712000)

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Updated Business Mailing Address January 26, 2010

Registered at 2300 N ROCKTON AVE, ROCKFORD, IL 611033619 (Tel: 8159712000)

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Provider Name / Credentials Updated January 26, 2010

Recorded as MICHAEL WAGNER, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 26, 2010

Ophthalmology (License #036-097924 in IL)

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Initial NPI Registration & Enumeration August 30, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164532354
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 30, 2006
Last Update: January 26, 2010
Deactivation Date: October 07, 2019

Mailing Address

2300 N Rockton Ave

Rockford, IL 611033619

Phone: 8159712000

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.