Ethan James Wagner, DPT
NPI 1104640879ActiveIndividual· Physical Therapist· Benton, AR
Physical Therapist (DPT) in Benton, Arkansas, licensed in AR, with an NPI issued in November 2024. Medicare paid $5,618 for services to 12 patients in 2024.
Overview
| NPI | 1104640879 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DPT |
| Sole proprietor | No |
| NPI issued | Nov 11, 2024 |
| Last updated in NPPES | Nov 11, 2024 |
| Certified by provider | Nov 11, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | PT5585 | AR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (AR) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 12 |
|---|---|
| Services billed | 290 across 8 procedure codes |
| Paid by Medicare | $5,618 |
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