Individual provider Active NPI

Marcus Wong, MD

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1326571654
Registry record updated Oct 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A169829 Issued in CA
Practice address
10001 Venice Blvd Apt 315
Los Angeles, CA 90034-6499
Phone
(619) 300-6912
NPI assigned
Apr 4, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 1326571654 IL
Emergency Medicine Physician 207P00000X 01083798A IN
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X A169829 CA Primary

Addresses

Primary practice location

10001 Venice Blvd Apt 315
Los Angeles, CA 90034-6499

Mailing address

10001 Venice Blvd Apt 315
Los Angeles, CA 90034-6499
Phone (619) 300-6912

Other practice location 1

1740 W Taylor St
Chicago, IL 60612-7232
Phone (619) 300-6912

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201106002040 CA Practitioner - Emergency Medicine 2668745894 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.65
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A169829CAMDEmergency Medicine Physician
1326571654ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Inyo Healthcare District CurrentSince Sep 26, 2024 Accepting new patients
Golden State Emergency Physicians Inc Emergency Medicine CurrentSince Nov 1, 2020 Accepting new patients
Southern Inyo Healthcare District CurrentSince Sep 26, 2024 Accepting new patients
Grand Avenue Emergency Physicians Medical Group Inc Emergency Medicine CurrentSince Dec 1, 2022 Accepting new patients

Locations

2215 Truxtun Ave
Bakersfield, CA 93301
Phone (661) 477-9283

1401 S Grand Ave
Los Angeles, CA 90015
Phone (213) 742-5555

Interoperability endpoints

  • Direct secure messaging: mwong18250@uihealth.direct-ci.com

Organizations & group practices 4

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": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729900800000",
    "number": "1326571654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 VENICE BLVD APT 315",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900346499",
            "telephone_number": "619-300-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 VENICE BLVD APT 315",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900346499",
            "telephone_number": "619-300-6912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1740 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127232",
            "country_code": "US",
            "telephone_number": "619-300-6912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "MARCUS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "1326571654",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01083798A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A169829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.