Individual provider Active NPI

Heather Wong, PAC

  • Physician Assistant
  • Ontario, CA
National Provider Identifier
1104367846
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54226 Issued in CA
Practice address
437 N Euclid Ave
Ontario, CA 91762-3456
Phone
(909) 988-2555
NPI assigned
Mar 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54226 CA Primary

Addresses

Primary practice location

437 N Euclid Ave
Ontario, CA 91762-3456

Mailing address

6690 Limonite Frontage Rd
Riverside, CA 92509
Phone (909) 450-5200

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170829002800 CA Practitioner - Physician Assistant 6709163264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stefani Lafrenierre MD IncGroup PAC ID 4082062526, 7 clinicians

Practice addresses (Care Compare)

1501 Superior Ave
Suite 210
Newport Beach, CA 92663-3640
Phone (949) 996-5355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54226CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 23, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 23, 2021 Accepting new patients

Locations

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1104367846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6690 LIMONITE FRONTAGE RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92509",
            "telephone_number": "909-450-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 N EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623456",
            "telephone_number": "909-988-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "HEATHER",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-14",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1011 Baldwin Park Blvd",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917065806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.