{"npi":"1265623268","type":"NPI-1","status":"active","name":{"display":"Dr. Jon Wagnon D.O.","other":[],"first":"JON","last":"WAGNON","middle":"ANTHONY","credential":"D.O."},"specialty":{"primary_taxonomy":"207P00000X","primary_taxonomy_description":"Emergency Medicine","slug":"emergency-medicine","schema_org_specialty":"Emergency","all":[{"code":"207Q00000X","description":"Family Medicine","primary":false,"state":"MO","license":"2006033803"},{"code":"207Q00000X","description":"Family Medicine","primary":false,"state":"IL","license":"036120316"},{"code":"207P00000X","description":"Emergency Medicine","primary":true,"state":"IL","license":"036120316"}]},"addresses":[{"purpose":"LOCATION","street_1":"1368 DADRIAN PROFESSIONAL PARK","city":"GODFREY","state":"IL","postal_code":"620351685","country_code":"US","phone":"6184339701","fax":"6184339706"},{"purpose":"MAILING","street_1":"1368 DADRIAN PROFESSIONAL PARK","city":"GODFREY","state":"IL","postal_code":"620351685","country_code":"US","phone":"6184339701","fax":"6184339706"}],"license":{"state":"IL","number":"036120316"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"036120316","state":"IL","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20081118000860","type_code":"14-08","type_desc":"PRACTITIONER - FAMILY PRACTICE","state":"IL","pac_id":"0345300596"}]},"enumeration_date":"2007-08-05","last_updated":"2025-05-14","_meta":{"source":"NPPES","snapshot_date":"2025-05-14","doc_url":"https://findmynpi.com/api"}}