Individual provider Active NPI

Philip Wong, MD

  • Urology Physician
  • Toledo, OH
National Provider Identifier
1003208026
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
35.139772 Issued in OH
Practice address
2120 W Central Ave
Toledo, OH 43606-3834
Phone
(419) 531-8558
Fax
(419) 697-7705
NPI assigned
Feb 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 4301502613 MI
Student in an Organized Health Care Education/Training Program 390200000X
Urology Physician 208800000X 35.139772 OH Primary

Addresses

Primary practice location

2120 W Central Ave
Toledo, OH 43606-3834

Mailing address

1 Seagate Ste 800
Toledo, OH 43604-1558
Phone (419) 531-8558

Other practice location 1

214 E Elm Ave Ste 101
Monroe, MI 48162-2678
Phone (734) 243-9620

Other practice location 2

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-7026

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pwong194434@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200721000475 MI Practitioner - Urology 1557676210 Reassigns benefits to 1 organization
I20200721000637 OH Practitioner - Urology 1557676210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Toledo College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Genito-Urinary Surgeons LLCGroup PAC ID 3971757238, 19 clinicians

Practice addresses (Care Compare)

2120 W Central Ave
Toledo, OH 43606-3834
Phone (419) 531-8558

905 N Macomb St
5 Promedica Genito Urinary LLC
Monroe, MI 48161-3076
Phone (734) 243-9620

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068
  • Bay Park Community Hospital Hospital, Oregon, OH, CCN 360259
  • Promedica Charles and Virginia Hickman Hospital Hospital, Adrian, MI, CCN 230005
  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099
  • Memorial Hospital Hospital, Fremont, OH, CCN 360156

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301502613MIMDUrology Physician
35.139772OHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Genito-Urinary Surgeons LLC Urology CurrentSince Aug 1, 2020 Accepting new patients
Genito Urinary Surgeons, Inc Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

905 N Macomb St
Ste 5
Monroe, MI 48162
Phone (734) 243-9620

214 E Elm Ave
Ste 101
Monroe, MI 48162
Phone (734) 243-9620

2751 Bay Park Dr
Ste 303
Oregon, OH 43616
Phone (419) 690-7676

1 Seagate
Ste 800
Toledo, OH 43604

2120 W Central Ave
Toledo, OH 43606
Phone (419) 531-8558

Interoperability endpoints

  • Direct secure messaging: pwong194434@direct.promedica.org

Organizations & group practices 3

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

Hospital & facility affiliations 7

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": "1424995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1003208026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "419-531-8558",
            "fax_number": "419-697-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 W CENTRAL AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063834",
            "telephone_number": "419-531-8558",
            "fax_number": "419-697-7705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 E Elm Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "MI",
            "postal_code": "481622678",
            "country_code": "US",
            "telephone_number": "734-243-9620",
            "fax_number": "734-243-3565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-7026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "PHILIP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-27",
        "last_updated": "2023-11-03",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301502613",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35.139772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pwong194434@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.