Individual provider Active NPI

Tai Wang, MD

  • Pulmonary Disease Physician
  • Portland, OR
National Provider Identifier
1457880973
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD220319 Issued in OR
Practice address
10201 SE Main St Ste 11
Portland, OR 97216-2937
Phone
(503) 253-2248
Fax
(503) 252-5166
NPI assigned
Jun 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2021-01222 NC
Internal Medicine Physician 207R00000X S2926 TX
Pulmonary Disease Physician 207RP1001X 2021-01222 NC
Pulmonary Disease Physician 207RP1001X MD220319 OR Primary

Addresses

Primary practice location

10201 SE Main St Ste 11
Portland, OR 97216-2937

Mailing address

1510 SW Alder St Apt 1816
Portland, OR 97205-1527
Phone (425) 941-8812

Other practice location 1

1 Baylor Plz # Bcm620
Houston, TX 77030-3411
Phone (713) 798-4951

Other practice location 2

Cb# 7020, 130 Mason Farm Rd
Chapel Hill, NC 27599-3411
Phone (919) 966-2531

Other names 1

  • Mary Wang Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twang726383@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20240709004760 OR Practitioner - Pulmonary Disease 0840612842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Portland Adventist Medical CenterGroup PAC ID 3274908819, 273 clinicians

Practice addresses (Care Compare)

10201 SE Main St
Suite 11
Portland, OR 97216-2937
Phone (503) 253-2248

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S2926TXMDInternal Medicine Physician
2021-01222NCMDPulmonary Disease Physician
MD220319ORMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Portland Adventist Medical Center Internal Medicine CurrentSince Jul 15, 2024 Accepting new patients
Portland Adventist Medical Center CurrentSince Jul 15, 2024 Accepting new patients

Locations

10151 SE Sunnyside Rd
Ste 100
Clackamas, OR 97015
Phone (503) 659-0880

10201 SE Main St
Ste 11
Portland, OR 97216
Phone (503) 224-8932

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

Interoperability endpoints

  • Direct secure messaging: twang173942@direct.ohsu.edu

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 3

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": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1457880973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 SW ALDER ST APT 1816",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051527",
            "telephone_number": "425-941-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SE MAIN ST STE 11",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162937",
            "telephone_number": "503-253-2248",
            "fax_number": "503-252-5166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz # Bcm620",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "713-798-4951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Cb# 7020, 130 Mason Farm Rd",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275993411",
            "country_code": "US",
            "telephone_number": "919-966-2531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "TAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2021-01222",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S2926",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "2021-01222",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OR",
            "license": "MD220319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twang726383@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "101 Manning Dr # 4220",
            "city": "Chapel Hill",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275144220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WANG",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.