SIMON B VAN WAGENEN, RPh — NPI 1790816072 (Licensed & Credentialed Pharmacist in STARKE, FL)

CMS-1500 Box 24J / 33a • NPI

1790816072

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

183500000X

Licensed & Credentialed Pharmacist

Box 32 Service Location & ZIP+4

470 W MADISON ST, STARKE, FL, 32091-3926

✓ 9-Digit EDI 837 ZIP+4 (32091-3926)

Practice Phone & Referral Fax

(904) 964-6759

Fax: (904) 964-5315

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1790816072 (SIMON B VAN WAGENEN, RPh) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1790816072` (NPI-1 Individual Practitioner)
Provider / Legal Name	SIMON B VAN WAGENEN, RPh
Plain-English Specialty	Licensed & Credentialed Pharmacist NUCC Code: `183500000X` (Pharmacist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	470 W MADISON ST, STARKE, FL, 32091-3926
Practice Telephone / Fax	Tel: (904) 964-6759 \| Fax: (904) 964-5315
Administrative Mailing Address	15604 SW 161ST ST, BROOKER, FL, 32622-2540
Enumeration & Last Sync	Enumerated: 2007-03-08 \| CMS Record Updated: 2007-07-09

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

470 W MADISON ST, STARKE, FL, 32091-3926

🗺️ Open in Google Maps 🏥 More Providers in STARKE

🔒 Are you SIMON B VAN WAGENEN, RPh? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (183500000X)

What Does Taxonomy Code 183500000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 183500000X translates to:
"Licensed & Credentialed Pharmacist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SIMON B VAN WAGENEN, RPh)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`183500000X` — Pharmacist Plain English: Licensed & Credentialed Pharmacist	State: FL \| License: `PS16532` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

SIMON B VAN WAGENEN, RPh (NPI #1790816072)