Individual provider Active NPI

Waichi Wong, MD

  • Internal Medicine Physician
  • Boston, MA
National Provider Identifier
1225019342
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
161332 Issued in MA
Practice address
55 Fruit St GRB 1003
Renal Associates
Boston, MA 02114-2696
Phone
(617) 726-5277
Fax
(617) 724-8652
NPI assigned
Nov 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 161332 MA Primary
Nephrology Physician 207RN0300X 161332 MA

Addresses

Primary practice location

55 Fruit St GRB 1003
Renal Associates
Boston, MA 02114-2696

Mailing address

PO Box 9142
Mass. General Physician Organization
Boston, MA 02129-9142
Phone (617) 724-0287

Other identifiers 3

IdentifierTypeStateIssuer
2073480MedicaidMA
469401OtherMATUFTS HEALTH PLAN
J27756OtherMABCBS OF MA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040825001252 MA Practitioner - NephrologyPractitioner - Internal Medicine 5294709093 Reassigns benefits to 2 organizations
Practice locations: Boston, MA

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
161332MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Jan 16, 2020 Accepting new patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Jan 16, 2020 Accepting new patients
Leslie S T Fang, MD, PC Internal Medicine PastSince Nov 28, 2008 Accepting new patients

Locations

55 Fruit St
#1003
Boston, MA 02114
Phone (617) 724-3874

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

151 Merrimac St
Fl 3
Boston, MA 02114
Phone (617) 726-3446

275 Sandwich St
Plymouth, MA 02360
Phone (508) 746-2000

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325116800000",
    "number": "1225019342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9142",
            "address_2": "MASS. GENERAL PHYSICIAN ORGANIZATION",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021299142",
            "telephone_number": "617-724-0287",
            "fax_number": "617-726-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST GRB 1003",
            "address_2": "RENAL ASSOCIATES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-726-5277",
            "fax_number": "617-724-8652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "WAICHI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2011-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "161332",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MA",
            "license": "161332",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2073480",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "469401",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MA",
            "identifier": "J27756",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.