DR. KELLY E VAN WAGNER (M.D.) – Internal Medicine Physician, NPI 1306035571
Internal Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. KELLY E VAN WAGNER (M.D.)
1380, European Drive, Seven Hills, Henderson, Clark County, Nevada, 89052, United States
HENDERSON, NV 890524020
Phone: (702) 419-3535
Type: Mailing
Boulder Highway, East Las Vegas, Whitney, Clark County, Nevada, 89122-7451, United States
LAS VEGAS, NV 891226077
Phone: (702) 940-1560
Fax: (702) 940-1561
Type: Location
5230 Boulder Hwy Ste 110
Las Vegas, NV 891226077
Phone: (702) 940-1560
Fax: (702) 940-1561
Type: Location
1380 European Dr
Henderson, NV 890524020
Phone: (702) 419-3535
Type: Location
6355 S Buffalo Dr Fl 3
Las Vegas, NV 891132133
Phone: (702) 216-3346
Fax: (702) 671-6883
Type: Location
6380 N. DECATUR BLVD
STE 215
N. LAS VEGAS, NV 89084
Phone: (702) 948-1145
Fax: (702) 949-6206
Type: Location
6355 S BUFFALO DR FL 3
LAS VEGAS, NV 891132133
Phone: (702) 216-3346
Fax: (702) 671-6883
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-03-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050311000240 | I | Internal Medicine | NV | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 38 | 37 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 31 | 31 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 15 | 13 | $0 |
| 80053 | Blood test, comprehensive group of blood chemicals | 12 | 11 | $0 |
| 93005 | Routine electrocardiogram (ecg) using at least 12 leads with tracing | 12 | 11 | $0 |
Insurance plans in this area (ZIP 89052)
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Group practice members
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