NPIMap

Individual provider Active NPI

Edward Kern Wong, MD

  • Internal Medicine Physician
  • Los Gatos, CA
National Provider Identifier
1093702151
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G69030 Issued in CA
Practice address
14911 National Ave
Ste 3
Los Gatos, CA 95032-2632
Phone
(408) 356-9121
Fax
(408) 356-4628
NPI assigned
Oct 4, 2005
Last updated
Mar 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G69030 CA Primary

Addresses

Primary practice location

14911 National Ave
Ste 3
Los Gatos, CA 95032-2632

Mailing address

14911 National Ave
Ste 3
Los Gatos, CA 95032-2632
Phone (408) 356-9121

Other identifiers 1

IdentifierTypeStateIssuer
GR0082830MedicaidCA

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
I20080611000877 CA Practitioner - Internal Medicine 1456422930 Practice locations: Los Gatos, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 1988
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

14911 National Ave
Suite 3
Los Gatos, CA 95032-2632
Phone (408) 356-9121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.45 of 100Reported as apm
Quality
74.21
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G69030CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: wong.edward.001.0050334@ekw.meditab.direct-ci.com
  • Direct secure messaging: wong.edward.007.0050334@ekw.meditab.direct-ci.com

Organizations & group practices 1

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 12

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": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553040000000",
    "number": "1093702151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14911 NATIONAL AVE",
            "address_2": "STE 3",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322632",
            "telephone_number": "408-356-9121",
            "fax_number": "408-356-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14911 NATIONAL AVE",
            "address_2": "STE 3",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322632",
            "telephone_number": "408-356-9121",
            "fax_number": "408-356-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "EDWARD",
        "middle_name": "KERN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2019-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G69030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0082830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

Verify at the official NPI Registry.