Individual provider Active NPI

Jerry Wong

  • Nurse Practitioner
  • Oakland, CA
National Provider Identifier
1124694377
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95024472 Issued in CA
Practice address
3850 Grand Ave
Oakland, CA 94610-1004
Phone
(888) 663-6331
Fax
(415) 252-7176
NPI assigned
May 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95244991 CA
Family Nurse Practitioner 363LF0000X 95024472 CA
Nurse Practitioner 363L00000X 95024472 CA Primary

Addresses

Primary practice location

3850 Grand Ave
Oakland, CA 94610-1004

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723

Other practice location 1

818 Webster St
Oakland, CA 94607-4220
Phone (510) 986-6800

Other practice location 2

750 Redwood Hwy Frontage Rd Ste 1210
Mill Valley, CA 94941-2483
Phone (888) 663-6331

Other identifiers 1

IdentifierTypeStateIssuer
95244991OtherCACALIFORNIA BOARD OF REGISTERED NURSING

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
I20230713003763 CA Practitioner - Nurse Practitioner 8123488715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
One Medical Group IncGroup PAC ID 2567623739, 330 clinicians

Practice addresses (Care Compare)

750 Redwood Hwy Frontage Rd
Suite 1210
Mill Valley, CA 94941-2483
Phone (888) 663-6331

Hospital & facility affiliations

  • Healthflex Home Health Services Home health agency, Oakland, CA, CCN 059551
  • Marinhealth Medical Center Hospital, Greenbrae, CA, CCN 050360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95244991CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
One Medical Group, Inc CurrentSince Aug 14, 2023 Accepting new patients
One Medical Group, Inc. CurrentSince Aug 14, 2023 Accepting new patients
University of California San Francisco Past Accepting new patients

Locations

350 Bon Air Ctr
Ste 200
Greenbrae, CA 94904
Phone (415) 578-3095

750 Redwood Hwy Frontage Rd
Ste 1210
Mill Valley, CA 94941

3850 Grand Ave
Oakland, CA 94610
Phone (510) 225-1013

1 Embarcadero Ctr
Ste 1900
San Francisco, CA 94111

1004 Northgate Dr
San Rafael, CA 94903
Phone (415) 590-6150

Organizations & group practices 3

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": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1124694377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 GRAND AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946101004",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "818 Webster St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946074220",
            "country_code": "US",
            "telephone_number": "510-986-6800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 Redwood Hwy Frontage Rd Ste 1210",
            "address_purpose": "LOCATION",
            "city": "Mill Valley",
            "state": "CA",
            "postal_code": "949412483",
            "country_code": "US",
            "telephone_number": "888-663-6331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "JERRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95244991",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95024472",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95024472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF REGISTERED NURSING",
            "identifier": "95244991",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.