NPIMap

Individual provider Active NPI

Tai-CHI Kwok, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Wooster, OH
National Provider Identifier
1407964315
Registry record updated Dec 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
35-074032 Issued in OH
Practice address
1761 Beall Ave
Suite 3C
Wooster, OH 44691-2342
Phone
(330) 345-5374
Fax
(330) 345-5814
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 35-074032 OH Primary
Adult Medicine Physician 207QA0505X 35074032 OH

Addresses

Primary practice location

1761 Beall Ave
Suite 3C
Wooster, OH 44691-2342

Mailing address

1761 Beall Ave
Suite 3C
Wooster, OH 44691-2342
Phone (330) 345-5374

Other identifiers 1

IdentifierTypeStateIssuer
2177059MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040805000098 OH Practitioner - Geriatric Medicine 1557332244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1761 Beall Ave
3C
Wooster, OH 44691-2342
Phone (330) 345-5374

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35074032OHMDAdult Medicine Physician
35-074032OHMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adult Geriatrics of Wooster, Inc. Geriatric Medicine CurrentSince Jul 1, 2006 Accepting new patients
Community Nephrology Services, Inc. PastSince Apr 1, 2014 Accepting new patients

Locations

1761 Beall Ave
#3C
Wooster, OH 44691
Phone (330) 345-5374

1761 Beall Ave
Ste 3C
Wooster, OH 44691
Phone (330) 345-5374

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9168/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wooster Community Hospital SNFWooster, OH, CCN 366405 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 24, 2014
Dec 24, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • City of Wooster

    dba Wooster Community Hospital SNF

    • Skilled Nursing Facility
    • Wooster, OH
    • NPI 1851665566

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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.

Hospital & facility affiliations 5

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419984000000",
    "number": "1407964315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 BEALL AVE",
            "address_2": "SUITE 3C",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912342",
            "telephone_number": "330-345-5374",
            "fax_number": "330-345-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BEALL AVE",
            "address_2": "SUITE 3C",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912342",
            "telephone_number": "330-345-5374",
            "fax_number": "330-345-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWOK",
        "first_name": "TAI-CHI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2014-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35-074032",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "OH",
            "license": "35074032",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2177059",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.