Individual provider Active NPI

Chen Wang, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Phoenix, AZ
National Provider Identifier
1174599260
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
59198 Issued in AZ
Practice address
424 S 56TH St Ste 110
Phoenix, AZ 85034-2177
Phone
(602) 685-5211
Fax
(480) 478-8091
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X 036-114610 IL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 59198 AZ Primary

Addresses

Primary practice location

424 S 56TH St Ste 110
Phoenix, AZ 85034-2177

Mailing address

4909 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone (309) 674-7546

Other practice location 1

4909 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone (309) 674-7546 ext. 430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191120003412 AZ Practitioner - Dermatology 1254353907 Reassigns benefits to 2 organizations
I20201112002089 CO Practitioner - Pathology 1254353907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.84 of 100Reported as group
Quality
62.03
Improvement activities
40
Cost
86.75

Merit-based Incentive Payment System (MIPS)

Final score
78.75 of 100Reported as group
Quality
75
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-114610ILMDDermatopathology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alta Vista Dermatology, LLC CurrentSince Jan 1, 2021 Accepting new patients
Regency Skin Institute PLLC CurrentSince Sep 1, 2019 Accepting new patients
Clin-Path Pathology Anatomic Pathology & Clinical Pathology CurrentSince Jul 9, 2023 Accepting new patients
Pathology Specialist of Arizona, LLP Anatomic Pathology & Clinical Pathology CurrentSince Sep 1, 2023 Accepting new patients
Sonoran Radiology LTD PastSince Sep 1, 2023 Accepting new patients
Tucson Pathology Associates P.C. Anatomic Pathology & Clinical Pathology Past Accepting new patients

Locations

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

10240 W Indian School Rd
Ste 115
Phoenix, AZ 85037
Phone (623) 243-9077

424 S 56th St
Ste 120
Phoenix, AZ 85034
Phone (480) 478-8059

424 S 56th St
Ste 110
Phoenix, AZ 85034
Phone (480) 478-8057

7350 E Speedway Blvd
Ste 101
Tucson, AZ 85710

206 W County Line Rd
Ste 340
Highlands Ranch, CO 80129
Phone (303) 888-6426

206 W County Line Rd
#340
Highlands Ranch, CO 80129
Phone (303) 888-6426

Organizations & group practices 6

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": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1174599260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 S 56TH ST STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850342177",
            "telephone_number": "602-685-5211",
            "fax_number": "480-478-8091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4909 N Glen Park Place Rd",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616144676",
            "country_code": "US",
            "telephone_number": "309-674-7546 x430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "CHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "IL",
            "license": "036-114610",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "59198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.