KYLE L WAGAMON (MD) – Dermatopathology Physician, NPI 1780758003

KYLE L WAGAMON (MD) is a healthcare provider. based in Warren, Ohio. specializing in DERMATOLOGY, PATHOLOGY. They hold the professional credentials MD. They hold a License No. 35083746 (OH). The NPI Number for KYLE L WAGAMON (MD) is 1780758003

Main info

Male
24 Years Of Experience
Accepts Medicare Assignment
Name
KYLE L WAGAMON (MD)
NPI
1780758003
Phone
(330) 393-4000
Address
2660 E MARKET ST
Enumeration Date
20 November 2006
Last Update Date
27 March 2026

Doctor Profile

Medical School Name
CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Secondary Phone
3308566365
Graduation Year
2002 (24 years ago)
PAC ID
6507968385
Group Practice PAC ID
8628384070
Professional Enrollment ID
I20070711000043
Address ID
OH444840000WA1745XNEXX501
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience67
Completeness85
Years active:19State licenses:1Digital endpointsOther names

607 DERMATOLOGY in OH

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Provider Addresses for KYLE L WAGAMON (MD)

  • 2660, East Market Street, Warren, Trumbull County, Ohio, 44483, United States

    WARREN, OH 444836204

    Phone: (330) 393-4000

    Fax: (330) 392-5870

    Type: Location

  • 2660 E Market St

    Warren, OH 444836204

    Phone: (330) 393-4000

    Fax: (330) 392-5870

    Type: Location

  • 1745 NILES CORTLAND RD NE STE 5

    WARREN, OH 444846046

    Phone: (330) 856-6365

    Fax: (330) 474-3981

    Type: Location

  • 19301, Cyclone Drive, Hopkins, Riverside, Cleveland, Cuyahoga County, Ohio, 44135, United States

    CLEVELAND, OH 441351731

    Phone: (330) 393-4000

    Fax: (330) 392-5870

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 13 Open Payments records for all available years, with a total value of $251.

Total Amount is formed as General ($251) + Research ($0) + Ownership ($0) = $251.

Last reported payment date: 2024-11-20 • Largest payer in this snapshot: Arcutis Biotherapeutics, Inc. ($60).

Total Amount

$251

General + Research + Ownership

Payments

13

Total payment records

General Amount

$251

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-20

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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: 2007-07-11

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20070711000043IDermatologyOHTBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths6,7971,020$0
17000Destruction of precancer skin growth, 1 growth1,8201,286$0
99213Established patient office or other outpatient visit, 20-29 minutes1,6901,246$0
11102Biopsy of related skin growth, first growth710590$0
17110Destruction of skin growth, 1-14 growths581474$0
View full utilization report →

Insurance plans in this area (ZIP 44483)

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Provider's Procedures

KYLE L WAGAMON (MD) performs procedures in DERMATOLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYOH17003Destruction of 2-14 skin growths58221021

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628384070View full group profile
NameSpecialtyState
Nurse PractitionerOH
D E R M A T O L O G YOH
Nurse PractitionerOH
-OH
D E R M A T O L O G YOH

Reviews

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Frequently asked questions

What is the standard ID for KYLE L WAGAMON (MD) in the U.S.?
In the U.S., KYLE L WAGAMON (MD) is identified by NPI 1780758003.
Is KYLE L WAGAMON (MD)'s NPI status active today?
Active status means KYLE L WAGAMON (MD)'s NPI record is not deactivated in the public file.
What services align with KYLE L WAGAMON (MD)'s listing?
KYLE L WAGAMON (MD)'s public classification highlights Dermatopathology Physician. Clinical services aligned with this taxonomy classification.
What geographic area is tied to KYLE L WAGAMON (MD)?
KYLE L WAGAMON (MD) is associated with Warren, Ohio in the same public data insurers reference.
Who maintains KYLE L WAGAMON (MD)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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