Active NPI
Wesley Blake Wong, M.D.
- Neurology Physician
- Indianapolis, IN
National Provider Identifier
1477610293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 01031410A
- Practice address
- 220 Virginia Ave
Mail No. In0205-A547
Indianapolis, IN 46204-3709 - Phone
- (317) 287-8524
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 01031410A | IN | Primary |
Addresses
Primary practice location
220 Virginia Ave
Mail No. In0205-A547
Indianapolis, IN 46204-3709
Mailing address
4753 E 136TH St
Carmel, IN 46033-9339
Phone (317) 843-9146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01031410A | IN | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477610293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4753 E 136TH ST",
"city": "CARMEL",
"state": "IN",
"postal_code": "460339339",
"telephone_number": "317-843-9146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 VIRGINIA AVE",
"address_2": "MAIL NO. IN0205-A547",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462043709",
"telephone_number": "317-287-8524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "WESLEY",
"middle_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IN",
"license": "01031410A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.