Individual provider Active NPI

Wenjun Wang Martin, AA

  • Anesthesiologist Assistant
  • Lake Wales, FL
National Provider Identifier
1144579525
Registry record updated Apr 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
AA323 Issued in FL
Practice address
410 S 11TH St
Lake Wales, FL 33853-4203
Phone
(863) 402-0064
NPI assigned
Aug 31, 2012
Last updated
Apr 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X AA323 FL Primary
Anesthesiologist Assistant 367H00000X 2012030849 MO

Addresses

Primary practice location

410 S 11TH St
Lake Wales, FL 33853-4203

Mailing address

PO Box 2327
Lake Wales, FL 33859-2327
Phone (863) 402-0064

Other names 1

  • Wenjun Wang Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160622001979 FL Practitioner - Anesthesiology Assistant 2668621301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ams National LLCGroup PAC ID 3870813025, 310 clinicians

Practice addresses (Care Compare)

410 S 11TH St
Lake Wales, FL 33853-4203
Phone (863) 676-1433

6002 Berryhill Rd
Milton, FL 32570-5062
Phone (850) 626-7762

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
AA323FLMDAnesthesiologist Assistant
2012030849MOMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Tampa Anesthesia Consultants CurrentSince Dec 21, 2016 Accepting new patients
Ams National LLC CurrentSince Jun 1, 2019 Accepting new patients

Locations

410 S 11th St
Lake Wales, FL 33853
Phone (863) 676-1433

2222 S Harbor City Blvd
Ste 540
Melbourne, FL 32901
Phone (321) 541-1776

6002 Berryhill Rd
Milton, FL 32570
Phone (850) 474-8688

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

10461 Quality Dr
Spring Hill, FL 34609
Phone (352) 688-3002

6733 Gall Blvd
Zephyrhills, FL 33542
Phone (813) 783-8242

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713052800000",
    "number": "1144579525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2327",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338592327",
            "telephone_number": "863-402-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-402-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "WENJUN",
        "middle_name": "WANG",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-31",
        "last_updated": "2024-04-14",
        "certification_date": "2024-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA323",
            "primary": true
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2012030849",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENJUN",
            "last_name": "WANG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.