Individual provider Active NPI

Jennifer L Wong, M.D.

  • Cardiovascular Disease Physician
  • Fountain Valley, CA
National Provider Identifier
1013029065
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A87388 Issued in CA
Practice address
18111 Brookhurst St Ste 5100
Fountain Valley, CA 92708-6728
Phone
(714) 546-2238
Fax
(714) 434-8145
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A87388 CA
Cardiovascular Disease Physician 207RC0000X A87388 CA Primary
Nuclear Cardiology Physician 207UN0901X A87388 CA
Clinical Cardiac Electrophysiology Physician 207RC0001X A87388 CA

Addresses

Primary practice location

18111 Brookhurst St Ste 5100
Fountain Valley, CA 92708-6728

Mailing address

18111 Brookhurst St Ste 5100
Fountain Valley, CA 92708-6728
Phone (714) 546-2238

Other identifiers 1

IdentifierTypeStateIssuer
1013029065MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20060410000455 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2264441864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of California, San Diego School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
California Heart AssociatesGroup PAC ID 3375519762, 13 clinicians

Practice addresses (Care Compare)

18111 Brookhurst St
Suite 5100
Fountain Valley, CA 92708-6728
Phone (714) 546-2238

Hospital & facility affiliations

  • Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603

Merit-based Incentive Payment System (MIPS)

Final score
94.55 of 100Reported as group
Quality
86.19
Improvement activities
40
Cost
74.79

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A87388CAMDNuclear Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
California Heart Associates CurrentSince Jul 1, 2011 Accepting new patients
Array Skin Therapy, a Medical Corporation Past Accepting new patients
Memorial Medical Group Inc Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Pacific Cardiovascular Associates Medical Group, Inc. Past Accepting new patients

Locations

18111 Brookhurst St
Ste 5100
Fountain Vly, CA 92708
Phone (714) 546-2238

18111 Brookhurst St
#5100
Fountain Vly, CA 92708
Phone (714) 546-2238

16300 Sand Canyon Ave
Ste 708
Irvine, CA 92618
Phone (949) 727-3884

20162 SW Birch St
Ste 260
Newport Beach, CA 92660
Phone (714) 549-2335

20162 SW Birch St
Newport Beach, CA 92660

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jwong136470@direct.memorialcare.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1013029065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18111 BROOKHURST ST STE 5100",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-546-2238",
            "fax_number": "714-434-8145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18111 BROOKHURST ST STE 5100",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-546-2238",
            "fax_number": "714-434-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A87388",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A87388",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "CA",
            "license": "A87388",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CA",
            "license": "A87388",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013029065",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.