Theodore Alan Wong, CRNA, RN

Key facts

NPI

1124601950

Entity type

Individual (NPI type 1)

Primary specialty

Certified Registered Nurse Anesthetist 367500000X

License

134436 (AL)

Practice address

1802 6TH Ave S
Birmingham, AL 35233-1932

Phone

(205) 934-3411

NPI assigned

Apr 29, 2021

Sex

Male

Sole proprietor

Yes

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.

• Blue Eagle Anesthesia Inc a Professional Corporation Anesthesiology Physician · Daly City, CA · NPI 1396822326
  Medicare reassignment Care Compare group NPD CA
• Permanente Medical Group Inc Internal Medicine Physician · Santa Clara, CA · NPI 1073606299
  Medicare reassignment Care Compare group NPD CA
• Permanente Medical Group, Inc. Clinical Medical Laboratory · Berkeley, CA · NPI 1083777163
  Care Compare group
• Permanente Medical Group Inc Internal Medicine Physician · Stockton, CA · NPI 1548343510
  NPD
• Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584
  NPD

Medicare Care Compare profile

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blue Eagle Anesthesia Inc a Professional Corporation (24 clinicians)
Permanente Medical Group Inc (10,928 clinicians)

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.3 of 100 (group)

Quality

59.22

Improvement activities

40

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 11, 2022.

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1124601950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 BRANNAN ST UNIT 677",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941035276",
            "telephone_number": "256-527-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 6TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331932",
            "telephone_number": "205-934-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "THEODORE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "CRNA, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-29",
        "last_updated": "2022-02-11",
        "certification_date": "2021-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95238443",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "134436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "275 W. Macarthur Blvd",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Birmingham, AL

• Emily Wong, M.D.
• Emily Beth Wong, MD
• Jerry Steven Wong, PHARM.D.
• Kristen Wong, MD
• Ryan Wai Yan Wong, MD
• Seoyeong Woo
• Alicia Eileen Woock, MD, PHD
• Amy Basinger Wood
• Barton Smith Wood, MD
• Christine Wood

All providers in Birmingham, AL · Certified Registered Nurse Anesthetist in Alabama