Justin Roman Wagner, PT
NPI 1669451472ActiveIndividual· Specialist· Cedar Rapids, IA
Specialist (PT) with Match Play Tennis Centers Inc, practicing in Cedar Rapids, Iowa. Medicare paid $46,400 for services to 79 patients in 2024.
Overview
| NPI | 1669451472 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT |
| Sole proprietor | No |
| NPI issued | Jan 10, 2006 |
| Last updated in NPPES | Oct 2, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | 03670 | IA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (IA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 79 |
|---|---|
| Services billed | 2,480 across 13 procedure codes |
| Paid by Medicare | $46,400 |
Education and affiliations
| Graduation year | 2001 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Match Play Tennis Centers IncCedar Rapids, IA · 13 clinicians
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