Active NPI 1831162791 Individual Practitioner Male Practitioner

Dr. Theodore T Wagner , MD

Urology • Lafayette, IN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Theodore Wagner, MD is a certified Urology practicing in Lafayette, IN. With approximately 32 years of clinical experience since graduating from Ohio State University College Of Medicine in 1994, Dr. Wagner delivers high-quality medical care to the local community at 3920 ST FRANCIS WAY STE 105.

Dr. Wagner accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, onabotulinumtoxina, 1 unit, established patient outpatient office visit, urinalysis, manual test. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3920 St Francis Way Ste 105

Lafayette, IN 479054917

Telephone 7655024000

Fax 7655024709

Associated Practice Facility / Clinic

🏢 Franciscan Health Lafayette Facility NPI 1356435341

Medicare Profile & Education

Medical School

Ohio State University College Of Medicine

Graduation Year

1994

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Lafayette, IN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

32 Yrs +9.6 yrs vs City Avg

City Avg: 22.4 Yrs

State Avg: 27.2 Yrs

Regional Practice Density

20 Specialists

Practicing in Lafayette, IN (320 Statewide)

Telehealth Adoption Rate

45.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

85.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Wagner (32 Years) 32 Yrs

Lafayette Specialty Average (22.4 Years) 22.4 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	7,300	38	$14.76	$6.25
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	458	366	$196.00	$119.11
81002 Urinalysis, manual test	191	150	$22.00	$3.41
99213 Established patient office or other outpatient visit, typically 15 minutes	162	148	$135.00	$84.51
81003 Automated urinalysis test	121	65	$21.00	$2.20
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	117	17	$4327.08	$179.05
52000 Diagnostic exam of bladder and urethra using an endoscope	106	91	$640.00	$219.07
J1580 Injection, garamycin, gentamicin, up to 80 mg	69	23	$5.43	$2.59
74420 Imaging of urinary tract	65	54	$94.00	$22.87
52287 Exam with injections of chemical for destruction of bladder using an endoscope	65	39	$1026.00	$352.79
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	52	52	$308.00	$155.12
52332 Insertion of stent in urinary duct (ureter) using an endoscope	36	32	$1915.00	$121.09
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	35	35	$219.00	$101.02
50590 Shock wave crushing of kidney stones	31	29	$3361.00	$526.78
52356 Crushing of stone of ureter with insertion of stent using an endoscope	27	25	$3593.00	$315.31
51798 Ultrasound measurement of bladder capacity after voiding	25	20	$111.00	$10.15
55700 Biopsy of prostate gland	19	19	$595.00	$220.37
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	17	17	$37.00	$13.34
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	14	$940.00	$53.67
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	13	13	$2890.00	$667.81
52353 Crushing of stone of ureter using an endoscope	12	12	$3636.08	$253.00

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	5,550	24	$14.76	$6.24
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	419	339	$191.34	$119.98
99213 Established patient office or other outpatient visit, typically 15 minutes	240	213	$131.38	$84.57
81002 Urinalysis, manual test	141	127	$22.00	$3.41
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	132	19	$4327.08	$168.12
52000 Diagnostic exam of bladder and urethra using an endoscope	108	95	$640.00	$224.33
81003 Automated urinalysis test	96	53	$21.00	$2.20
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	81	16	$3435.00	$46.95
74420 Imaging of urinary tract	75	64	$94.00	$22.73
J1580 Injection, garamycin, gentamicin, up to 80 mg	48	16	$5.43	$2.64
52287 Exam with injections of chemical for destruction of bladder using an endoscope	46	24	$1026.00	$363.75
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	45	45	$215.80	$105.08
52332 Insertion of stent in urinary duct (ureter) using an endoscope	35	31	$1822.60	$111.27
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	32	32	$300.78	$156.91
52356 Crushing of stone of ureter with insertion of stent using an endoscope	24	22	$3499.00	$362.96
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	22	19	$108.00	$31.45
50590 Shock wave crushing of kidney stones	20	19	$3361.00	$533.10
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	16	16	$4860.00	$184.65
55700 Biopsy of prostate gland	16	16	$595.00	$222.95
76872 Ultrasound scan of pelvic region through rectum	15	15	$458.00	$121.03
52352 Removal or manipulation of stone in ureter or kidney using an endoscope	14	14	$3375.00	$235.75
52353 Crushing of stone of ureter using an endoscope	13	13	$3478.00	$297.53
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	13	13	$989.00	$277.02

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	6,100	34	$12.79	$6.14
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	586	439	$196.00	$121.00
99213 Established patient office or other outpatient visit, typically 15 minutes	321	264	$135.00	$85.12
81003 Automated urinalysis test	276	177	$21.00	$2.22
52000 Diagnostic exam of bladder and urethra using an endoscope	119	101	$640.00	$228.19
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	117	17	$4257.00	$178.15
81002 Urinalysis, manual test	78	73	$22.00	$3.40
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	64	14	$3435.00	$47.49
52287 Exam with injections of chemical for destruction of bladder using an endoscope	50	34	$1026.00	$372.55
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	47	47	$308.00	$157.92
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	45	45	$219.00	$104.96
74420 Imaging of urinary tract	37	31	$94.00	$23.89
52332 Insertion of stent in urinary duct (ureter) using an endoscope	22	19	$1995.18	$123.33
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	14	13	$108.00	$31.06
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	14	14	$4860.00	$189.74
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	13	13	$989.00	$303.14
50590 Shock wave crushing of kidney stones	12	12	$3361.00	$537.94
99221 Initial hospital inpatient care per day, typically 30 minutes	11	11	$190.00	$94.10
52356 Crushing of stone of ureter with insertion of stent using an endoscope	11	11	$3729.73	$405.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	3,600	21	$12.79	$6.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	509	380	$175.00	$121.76
99213 Established patient office or other outpatient visit, typically 15 minutes	369	310	$120.00	$85.63
81002 Urinalysis, manual test	237	184	$22.00	$3.47
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	160	22	$826.00	$188.81
52000 Diagnostic exam of bladder and urethra using an endoscope	128	101	$640.00	$218.72
81003 Automated urinalysis test	76	64	$21.00	$2.23
J1580 Injection, garamycin, gentamicin, up to 80 mg	65	16	$3.91	$1.84
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	53	53	$195.00	$100.12
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	47	45	$80.00	$51.82
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	33	11	$3435.00	$48.38
51798 Ultrasound measurement of bladder capacity after voiding	31	30	$111.00	$9.28
52287 Exam with injections of chemical for destruction of bladder using an endoscope	29	21	$1026.00	$363.84
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	27	22	$108.00	$30.21
74420 Imaging of urinary tract	26	25	$94.00	$23.42
99202 New patient office or other outpatient visit, typically 20 minutes	23	23	$135.00	$68.50
76872 Ultrasound scan of pelvic region through rectum	18	18	$458.00	$130.18
55700 Biopsy of prostate gland	15	15	$595.00	$235.46
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$275.00	$158.64
52332 Insertion of stent in urinary duct (ureter) using an endoscope	14	13	$1789.00	$96.03
50590 Shock wave crushing of kidney stones	13	13	$3361.00	$539.43
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	11	11	$4860.00	$198.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	2,500	17	$13.04	$6.07
99213 Established patient office or other outpatient visit, typically 15 minutes	494	397	$129.92	$71.40
81003 Automated urinalysis test	223	169	$16.83	$2.22
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	207	179	$181.04	$104.35
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	186	176	$80.00	$43.01
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	139	18	$685.28	$223.36
51798 Ultrasound measurement of bladder capacity after voiding	124	102	$66.99	$9.38
84153 Psa (prostate specific antigen) measurement, total	123	110	$80.00	$18.14
52000 Diagnostic exam of bladder and urethra using an endoscope	112	83	$567.50	$199.80
36415 Insertion of needle into vein for collection of blood sample	106	104	$10.09	$2.96
81002 Urinalysis, manual test	86	80	$22.00	$3.48
J1580 Injection, garamycin, gentamicin, up to 80 mg	72	17	$3.88	$1.83
99202 New patient office or other outpatient visit, typically 20 minutes	58	58	$137.84	$72.18
87086 Bacterial colony count, urine	55	40	$30.00	$7.95
87184 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)	33	23	$34.00	$7.38
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	27	27	$30.00	$7.66
84403 Testosterone (hormone) level, total	25	23	$110.00	$25.44
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	24	17	$93.00	$29.72
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	24	24	$197.92	$102.49
52332 Insertion of stent in urinary duct (ureter) using an endoscope	22	19	$1404.59	$132.32
52287 Exam with injections of chemical for destruction of bladder using an endoscope	22	17	$976.36	$343.29
74420 Imaging of urinary tract	21	16	$158.38	$25.07
55700 Biopsy of prostate gland	18	18	$592.56	$238.72
87077 Bacterial culture for aerobic isolates	17	12	$38.00	$7.97
87088 Bacterial urine culture	17	16	$39.00	$8.00
80048 Blood test, basic group of blood chemicals (calcium, total)	17	16	$30.00	$8.34
76872 Ultrasound scan of pelvic region through rectum	14	14	$446.71	$136.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	30,200	20	$0.61	$0.03
J0585 Injection, onabotulinumtoxina, 1 unit	2,900	22	$13.68	$6.03
99213 Established patient office or other outpatient visit, typically 15 minutes	797	577	$140.00	$70.52
81003 Automated urinalysis test	496	329	$15.00	$2.43
36415 Insertion of needle into vein for collection of blood sample	355	306	$10.00	$2.93
51798 Ultrasound measurement of bladder capacity after voiding	332	235	$58.05	$11.72
84153 Psa (prostate specific antigen) measurement, total	300	234	$80.00	$20.03
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	256	231	$80.00	$42.64
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	165	23	$500.00	$224.78
87086 Bacterial colony count, urine	163	97	$30.00	$8.79
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	153	48	$50.00	$15.85
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	148	120	$200.00	$103.06
52000 Diagnostic exam of bladder and urethra using an endoscope	133	94	$500.00	$178.40
87184 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)	97	64	$34.00	$7.51
87088 Bacterial urine culture	91	60	$39.00	$8.81
J1580 Injection, garamycin, gentamicin, up to 80 mg	78	26	$3.20	$1.75
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	78	66	$30.00	$8.46
99202 New patient office or other outpatient visit, typically 20 minutes	57	57	$140.00	$72.30
84403 Testosterone (hormone) level, total	53	38	$110.00	$28.11
80048 Blood test, basic group of blood chemicals (calcium, total)	50	47	$30.00	$9.21
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	43	13	$180.00	$58.86
82670 Measurement of total estradiol (hormone)	40	30	$120.00	$30.42
51700 Simple bladder irrigation and/or instillation	30	22	$190.00	$36.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	30	30	$200.00	$102.33
52287 Exam with injections of chemical for destruction of bladder using an endoscope	29	22	$870.00	$321.54
76872 Ultrasound scan of pelvic region through rectum	28	28	$268.57	$121.16
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	27	27	$175.00	$54.43
55700 Biopsy of prostate gland	27	27	$551.00	$237.62
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	25	21	$72.00	$29.14
74420 Imaging of urinary tract	23	21	$198.00	$25.28
76000 Imaging guidance for procedure, 60 minutes or less	15	15	$150.00	$14.84
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	13	13	$480.00	$220.26
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	12	12	$2100.00	$707.81
74178 Ct scan of abdomen and pelvis before and after contrast	12	12	$1100.00	$229.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	51,100	23	$0.61	$0.02
J0585 Injection, onabotulinumtoxina, 1 unit	2,300	15	$13.68	$6.05
99213 Established patient office or other outpatient visit, typically 15 minutes	810	526	$140.00	$68.42
81003 Automated urinalysis test	537	381	$15.00	$2.70
51798 Ultrasound measurement of bladder capacity after voiding	476	319	$60.00	$14.45
36415 Insertion of needle into vein for collection of blood sample	412	297	$10.00	$2.93
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	317	283	$80.00	$41.06
84153 Psa (prostate specific antigen) measurement, total	314	221	$80.00	$22.19
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	237	52	$50.00	$19.20
99202 New patient office or other outpatient visit, typically 20 minutes	201	200	$140.00	$70.38
87086 Bacterial colony count, urine	181	94	$30.00	$9.76
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	178	22	$514.04	$214.18
52000 Diagnostic exam of bladder and urethra using an endoscope	135	111	$500.00	$155.25
87184 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)	111	59	$34.00	$8.34
J1580 Injection, garamycin, gentamicin, up to 80 mg	90	29	$3.20	$1.46
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	87	67	$30.00	$9.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	85	71	$200.00	$101.53
87088 Bacterial urine culture	56	39	$39.00	$9.79
84403 Testosterone (hormone) level, total	56	35	$110.00	$31.23
87077 Bacterial culture for aerobic isolates	55	35	$38.00	$9.77
80048 Blood test, basic group of blood chemicals (calcium, total)	52	47	$30.00	$10.23
51702 Simple insertion of temporary bladder tube	49	20	$200.00	$57.83
82670 Measurement of total estradiol (hormone)	44	26	$120.00	$33.80
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	32	23	$72.00	$28.72
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	31	31	$200.00	$100.87
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	30	29	$175.00	$56.50
55700 Biopsy of prostate gland	30	29	$530.60	$234.75
76872 Ultrasound scan of pelvic region through rectum	30	29	$220.00	$90.93
52287 Exam with injections of chemical for destruction of bladder using an endoscope	23	15	$870.00	$294.73
51700 Simple bladder irrigation and/or instillation	23	15	$174.35	$34.64
74420 Imaging of urinary tract	20	19	$198.00	$17.12
74176 Ct scan of abdomen and pelvis without contrast	14	14	$587.14	$139.97
76000 Imaging guidance for procedure, 60 minutes or less	12	11	$150.00	$8.25
74178 Ct scan of abdomen and pelvis before and after contrast	11	11	$1081.82	$236.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	49,500	19	$0.61	$0.02
J0585 Injection, onabotulinumtoxina, 1 unit	4,300	29	$13.68	$5.88
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	1,200	12	$10.00	$0.12
99213 Established patient office or other outpatient visit, typically 15 minutes	746	465	$140.00	$68.70
81003 Automated urinalysis test	675	371	$15.00	$3.01
51798 Ultrasound measurement of bladder capacity after voiding	363	236	$60.00	$17.59
36415 Insertion of needle into vein for collection of blood sample	298	211	$10.00	$2.93
84153 Psa (prostate specific antigen) measurement, total	222	158	$80.00	$24.73
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	219	191	$80.00	$40.85
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	216	37	$50.00	$23.75
87086 Bacterial colony count, urine	175	98	$30.00	$10.85
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	129	17	$500.00	$207.63
52000 Diagnostic exam of bladder and urethra using an endoscope	104	82	$500.00	$153.28
99202 New patient office or other outpatient visit, typically 20 minutes	96	96	$140.00	$69.65
87184 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)	93	56	$34.00	$9.27
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	79	61	$30.00	$10.33
87077 Bacterial culture for aerobic isolates	70	46	$38.00	$10.86
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	63	54	$200.00	$100.19
80048 Blood test, basic group of blood chemicals (calcium, total)	60	57	$30.00	$8.58
J1580 Injection, garamycin, gentamicin, up to 80 mg	57	19	$3.20	$1.51
84403 Testosterone (hormone) level, total	46	27	$110.00	$34.70
51700 Simple bladder irrigation and/or instillation	39	29	$170.00	$34.03
52287 Exam with injections of chemical for destruction of bladder using an endoscope	38	29	$870.00	$292.40
82670 Measurement of total estradiol (hormone)	37	22	$120.00	$37.55
51702 Simple insertion of temporary bladder tube	36	12	$200.00	$56.83
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	29	19	$72.00	$30.18
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$200.00	$101.24
87088 Bacterial urine culture	23	17	$39.00	$10.88
55700 Biopsy of prostate gland	18	18	$515.00	$232.60
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	18	18	$175.00	$56.86
76872 Ultrasound scan of pelvic region through rectum	18	18	$220.00	$85.96
74420 Imaging of urinary tract	16	15	$198.00	$16.34
76000 Imaging guidance for procedure, 60 minutes or less	14	14	$150.00	$7.87
52352 Removal or manipulation of stone in ureter or kidney using an endoscope	13	12	$850.00	$219.58
74178 Ct scan of abdomen and pelvis before and after contrast	11	11	$900.00	$230.70

Medical Specialties & State Licenses

CMS Verified: 2026-03-24

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License IN 01050471A

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

100081380 (IN)

Medicaid State Provider ID

0748972 (OH)

Medicaid State Provider ID

200245650 (IN)

Medicaid State Provider ID

2568556 (OH)

Commercial Insurance / Payer ID Anthem Bc/bs

000000087512 (IN)

Secondary Practice Locations

11141 Parkview Plaza Dr Ste 325

Fort Wayne, IN 468451714

Phone: 2604255400

Practice Associates & Co-Workers

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

40 Associated Practitioners

Jahan Ali Khajeh

Hospitalist

NPI 1013648666

Ashley Schmitt , RN

Registered Nurse

NPI 1033081237

Registered Nurse

Dr. Andrew Alaimo , DO

Emergency Medicine

NPI 1033134382

Doctor of Osteopathic Medicine (D.O.)

Dr. Samir Shah , MD

Hospitalist

NPI 1053592501

Doctor of Medicine (M.D.)

Adeola Oviawe

Hospitalist

NPI 1053775239

Abigail Chew

Specialist/Technologist - Athletic Trainer

NPI 1073170627

Career & Practice History Timeline

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

11 Historical Events

📍

Updated Practice Location March 24, 2026

Registered at 3920 ST FRANCIS WAY STE 105, LAFAYETTE, IN 479054917 (Tel: 7655024000)

📍

Updated Business Mailing Address March 24, 2026

Registered at PO BOX 781076, DETROIT, MI 482781076 (Tel: 3175284800)

📍

Updated Practice Location March 21, 2023

Registered at 11141 PARKVIEW PLAZA DR STE 325, FORT WAYNE, IN 468451714 (Tel: 2604255400)

📍

Updated Business Mailing Address March 21, 2023

Registered at 11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 468451701

📍

Updated Business Mailing Address June 25, 2020

Registered at 3702 NEW VISION DR BLDG B, FORT WAYNE, IN 468451703 (Tel: 2602666013)

✅

NPI Profile Active February 29, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location February 29, 2012

Registered at 2512 E DUPONT RD, STE. 100, FORT WAYNE, IN 468251675 (Tel: 2604366667)

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Updated Business Mailing Address February 29, 2012

Registered at 10351 DAWSONS CREEK BLVD, STE D, FORT WAYNE, IN 468251904 (Tel: 2609691950)

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Provider Name / Credentials Updated February 29, 2012

Recorded as THEODORE WAGNER, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 29, 2012

Urology (License #01050471A in IN)

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Initial NPI Registration & Enumeration February 10, 2006

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1831162791

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 10, 2006

Last Update: March 24, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 781076

Detroit, MI 482781076

Phone: 3175284800

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

⚠️ Medical Disclaimer

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