MATTHEW A WAGGONER (P.A.-C.) – Physician Assistant, NPI 1710991732
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,703 PHYSICIAN ASSISTANT in WI
Provider Addresses for MATTHEW A WAGGONER (P.A.-C.)
800 Riverside Dr
Waupaca, WI 549811943
Phone: (715) 258-1000
Type: Location
100 County Road B
Shawano, WI 541667072
Phone: (715) 526-7308
Type: Location
South State Street, Ann Arbor, Washtenaw County, Michigan, 48108-1774, United States
700 KMS PLACE
ANN ARBOR, MI 48108
Phone: (734) 936-2047
Type: Mailing
Mott Children's Hospital and Von Voigtlander Women's Hospital, 1500, East Medical Center Drive, Ann Arbor, Washtenaw County, Michigan, 48109, United States
B1FLOOR CANCER & GERIATRICS CENTER RECP C
ANN ARBOR, MI 481090916
Phone: (734) 936-6000
Type: Location
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: 2026-01-31
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
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 |
|---|---|---|---|---|
| I20070427000110 | I | Physician Assistant | MI | TBD |
| I20181116001184 | I | Physician Assistant | WI | TBD |
| I20200430002394 | I | Physician Assistant | NY | TBD |
| I20260131000755 | I | Physician Assistant | IL | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 54981)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IA | |
| - | IA | |
| Interventional Cardiology, Cardiovascular Disease (Cardiology) | IA | |
| - | IA | |
| Emergency Medicine, Internal Medicine | IA | |
| - | IA | |
| - | IA | |
| Emergency Medicine, Family Practice | IA | |
| H O S P I T A L I S T | IL | |
| - | NV |
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