Individual provider Active NPI

Ericka Shin Wong, M.D.

  • Neurology Physician
  • Philadelphia, PA
National Provider Identifier
1083975015
Registry record updated Dec 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD464846 Issued in PA
Practice address
909 Walnut St FL 2
Philadelphia, PA 19107-5211
Phone
(215) 955-1234
NPI assigned
Jun 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 279372 NY
Neurology Physician 2084N0400X MD464846 PA Primary

Addresses

Primary practice location

909 Walnut St FL 2
Philadelphia, PA 19107-5211

Mailing address

909 Walnut St FL 2
Philadelphia, PA 19107-5211
Phone (215) 955-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20181221001125 PA Practitioner - Neurology 6406147990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
New York Medical College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-7000

Hospital & facility affiliations

  • Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
  • Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD464846PAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Nov 6, 2018 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

1101 Chestnut St
Fl 10
Philadelphia, PA 19107
Phone (215) 587-3000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

909 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

Organizations & group practices 2

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 2

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1083975015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-1234",
            "fax_number": "215-923-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "ERICKA",
        "middle_name": "SHIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-06",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "279372",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD464846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.