Individual provider Active NPI

Jason Ma Wong, MPT

  • Physical Therapist
  • Los Altos, CA
National Provider Identifier
1376501411
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
27604 Issued in CA
Practice address
5050 El Camino Real
Suite 210
Los Altos, CA 94022-1530
Phone
(650) 559-0011
Fax
(650) 559-0012
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 27604 CA Primary

Addresses

Primary practice location

5050 El Camino Real
Suite 210
Los Altos, CA 94022-1530

Mailing address

4 Sorrel LN
San Carlos, CA 94070-1530
Phone (650) 591-3976

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100111000660 CA Practitioner - Physical Therapist in Private Practice 2769523893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
May accept Medicare assignment
Group practices
Apogee Rehabilitative Therapy ServicesGroup PAC ID 9739343492, 8 clinicians

Practice addresses (Care Compare)

1716 Miramonte Ave
Mountain View, CA 94040-3763
Phone (650) 934-0455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27604CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Silicon Valley Hand Therapy Physical Therapist CurrentSince Jul 1, 2018 Accepting new patients
Apogee Rehabilitative Therapy Services Physical Therapist CurrentSince Nov 1, 2017 Accepting new patients

Locations

1716 Miramonte Ave
Mountain View, CA 94040
Phone (650) 934-0455

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1376501411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 SORREL LN",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940701530",
            "telephone_number": "650-591-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 EL CAMINO REAL",
            "address_2": "SUITE 210",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221530",
            "telephone_number": "650-559-0011",
            "fax_number": "650-559-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "JASON",
        "middle_name": "MA",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "27604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Altos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; 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.