MR. PHILIP WAGENBACH (PA-C) – Medical Physician Assistant, NPI 1790797116
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
385 PHYSICIAN ASSISTANT in VT
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Provider Addresses for MR. PHILIP WAGENBACH (PA-C)
Vermont Route 30 North, Bomoseen, Castleton, Rutland County, Vermont, 05732, United States
BOMOSEEN, VT 057329647
Phone: (802) 468-5641
Fax: (802) 468-2923
Type: Location
700, School Street, Pawtucket, Providence County, Rhode Island, 02860, United States
PAWTUCKET, RI 028605747
Phone: (401) 616-2000
Fax: (401) 616-2001
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2015-11-19
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 |
|---|---|---|---|---|
| I20151119000526 | I | Physician Assistant | VT | 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 |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 40 | 39 | $0 |
| 81003 | Automated urinalysis test | 35 | 34 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 31 | 29 | $0 |
Insurance plans in this area (ZIP 05732)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | VT | |
| - | VT | |
| - | VT | |
| Family Practice | VT | |
| - | VT | |
| Internal Medicine, Obstetrics/Gynecology, Family Practice | VT | |
| - | VT | |
| Physician Assistant | VT | |
| - | VT | |
| Nurse Practitioner | VT |
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