Individual provider Active NPI

Granger Bradford Wong, MD,DMD,FACS

  • Plastic Surgery Physician
  • Sacramento, CA
National Provider Identifier
1225013790
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
A54333 Issued in CA
Practice address
2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone
(916) 734-2130
NPI assigned
Dec 7, 2005
Last updated
Mar 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ph.D. Medical Genetics 170100000X A54333 CA
Plastic Surgery Physician 208200000X A54333 CA Primary

Addresses

Primary practice location

2221 Stockton Blvd
Sacramento, CA 95817-1418

Mailing address

2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone (916) 734-2130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, HI2 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
I20071105000405 CA Practitioner - Plastic and Reconstructive SurgeryPractitioner - General SurgeryPractitioner - Maxillofacial Surgery 2567559743 Reassigns benefits to 2 organizations
I20081201000141 HI Practitioner - Plastic and Reconstructive Surgery 2567559743 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Nebraska College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

1401 S Beretania St
Suite 999
Honolulu, HI 96814-1870
Phone (916) 791-7088

500 W Hospital Rd
French Camp, CA 95231-9693
Phone (209) 468-6000

576 N Sunrise Ave
Suite 120
Roseville, CA 95661-2846
Phone (916) 791-7088

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.15 of 100Reported as group
Quality
64.8
Promoting interoperability
100
Improvement activities
40
Cost
68.65

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A54333CAMDPh.D. Medical Genetics

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Aug 3, 1998 Accepting new patients
James H. Rosing, MD, Inc. Plastic Surgery CurrentSince Mar 16, 2015 Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 3, 1998 Accepting new patients
Granger B Wong M D Inc Plastic Surgery CurrentSince Mar 11, 2002 Accepting new patients
Kapiolani Medical Center Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

576 N Sunrise Ave
Ste 120
Roseville, CA 95661
Phone (916) 786-2020

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

3301 C St
Sacramento, CA 95816
Phone (916) 734-6111

3301 C St
Ste 1100
Sacramento, CA 95816
Phone (916) 734-7844

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4868 X St
Sacramento, CA 95817
Phone (916) 703-1503

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

1401 S Beretania St
Ste 999
Honolulu, HI 96814
Phone (808) 525-6590

Organizations & group practices 8

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 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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394409600000",
    "number": "1225013790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171418",
            "telephone_number": "916-734-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171418",
            "telephone_number": "916-734-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "GRANGER",
        "middle_name": "BRADFORD",
        "name_prefix": "Dr.",
        "credential": "MD,DMD,FACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2014-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "CA",
            "license": "A54333",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A54333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.