NPIMap

Individual provider Active NPI

Jackson Wang, MD

  • Nephrology Physician
  • Grass Valley, CA
National Provider Identifier
1003183617
Registry record updated May 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A119259 Issued in CA
Practice address
10058 Wolf Rd
Grass Valley, CA 95949-8194
Phone
(530) 268-7708
NPI assigned
Nov 28, 2011
Last updated
May 19, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A119259 CA Primary

Addresses

Primary practice location

10058 Wolf Rd
Grass Valley, CA 95949-8194

Mailing address

10058 Wolf Rd
Grass Valley, CA 95949-8194
Phone (530) 268-7708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702001421 CA Practitioner - Nephrology 4688986722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Nephrology Medical Group, Inc.Group PAC ID 9638107733, 10 clinicians

Practice addresses (Care Compare)

10044 Wolf Rd
Suite a
Grass Valley, CA 95949-8193
Phone (530) 268-7708

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A119259CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Nephrology Medical Group, Inc Nephrology CurrentSince Apr 11, 2015 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Sutter Coast Hospital Past Accepting new patients
Sierra Nevada Memorial-Miners Hospital Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

11969 Heritage Oak Pl
Auburn, CA 95603
Phone (530) 878-5950

10044 Wolf Rd
Ste A
Grass Valley, CA 95949
Phone (530) 268-7708

10058 Wolf Rd
Grass Valley, CA 95949
Phone (530) 268-0847

151 N Sunrise Ave
Ste 1202
Roseville, CA 95661
Phone (916) 789-1505

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

Interoperability endpoints

  • Direct secure messaging: jwang206481@hisp.ehr.sutterhealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431993600000",
    "number": "1003183617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10058 WOLF RD",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959498194",
            "telephone_number": "530-268-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10058 WOLF RD",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959498194",
            "telephone_number": "530-268-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JACKSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-28",
        "last_updated": "2015-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A119259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Valley, CA

Sources for this page

Verify at the official NPI Registry.