Ethan Wagner, DPT
NPI 1104640879 · Physical Therapist · Benton, AR
Enrolled with Medicare as Practitioner - Physical Therapist in Private Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Ethan Wagner, DPT is a Physical Therapist provider in Benton, AR (NPI 1104640879).
Provider details
- NPI number
- 1104640879
- Entity type
- Individual
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- DPT
- Sex
- Male
- Sole proprietor
- No
- License
- PT5585 (AR)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
1 yr in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
260 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Therapy Procedure Using Manual Technique, Each 15 Minutes97140 | 71 | $20 |
| Therapy Procedure Using Exercise to Develop Strength, Endurance, Range of Motion, and Flexibility, Each 15 Minutes97110 | 66 | $21 |
| Therapy Procedure Using Functional Activities97530 | 64 | $31 |
| Therapy Procedure to Re-Educate Brain-To-Nerve-To-Muscle Function, Each 15 Minutes97112 | 59 | $25 |
Typical Medicare-allowed amounts for these services range $20–$31 (2024). The Medicare-allowed amount is what Medicare recognizes for a service under fee-for-service — a reference figure for 2024, not a price quote and not what you would be billed. Medicare Part B covers roughly an eighth of all NPIs (65+ skew); services with fewer than 11 beneficiaries are suppressed by CMS. Source: CMS Medicare Physician & Other Practitioners, by Provider & Service.
Practice location
Mailing address
Registry dates
- Enumerated
- 2024-11-11
- Last updated
- 2024-11-11
- Certified
- 2024-11-11
Frequently asked questions
- What is Ethan Wagner's NPI number?
- Ethan Wagner's National Provider Identifier (NPI) is 1104640879, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Ethan Wagner's specialty?
- Ethan Wagner is listed in the NPPES registry with a primary specialty of Physical Therapist (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Ethan Wagner located?
- Ethan Wagner's practice location on file with NPPES is 20320 I 30 # 190, Benton, AR 72019-8027.
- What is Ethan Wagner's phone number?
- The practice phone number listed in the NPPES registry for Ethan Wagner is (501) 500-8188.
- Does Ethan Wagner accept Medicare?
- Ethan Wagner is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Ethan Wagner's NPI active?
- Yes — Ethan Wagner's NPI (1104640879) is active in the NPPES registry as of the last update on 2024-11-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.