NPIMap

Individual provider Active NPI

Roque Alberto Diaz Wong, M.D.

  • Nephrology Physician
  • San Antonio, TX
National Provider Identifier
1477758357
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
P5965 Issued in TX
Practice address
4330 Medical Dr Ste 105
San Antonio, TX 78229-3342
Phone
(210) 692-7228
Fax
(210) 692-9671
NPI assigned
Jun 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301089787 MI
Nephrology Physician 207RN0300X P5965 TX Primary

Addresses

Primary practice location

4330 Medical Dr Ste 105
San Antonio, TX 78229-3342

Mailing address

7142 San Pedro Ave
Suite 120
San Antonio, TX 78216-6256
Phone (210) 661-5622

Other identifiers 1

IdentifierTypeStateIssuer
324927801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20130806000190 TX Practitioner - NephrologyPractitioner - Internal Medicine 9739345257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4330 Medical Dr
Suite 105
San Antonio, TX 78229-3353
Phone (210) 692-7228

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.76 of 100Reported as group
Quality
67.88
Promoting interoperability
87
Improvement activities
40
Cost
78.84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301089787MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Antonio Kidney Disease Center Physicians Group, P.L.L.C. Nephrology CurrentSince Jul 1, 2013 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients

Locations

7142 San Pedro Ave
Ste 120
San Antonio, TX 78216
Phone (210) 481-7453

8042 Wurzbach Rd
Ste 500
San Antonio, TX 78229
Phone (210) 692-7228

4330 Medical Dr
Ste 105
San Antonio, TX 78229
Phone (210) 692-7228

Interoperability endpoints

  • Direct secure messaging: roquediazwong@sakdc.allscriptsdirect.net

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 9

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": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1477758357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7142 SAN PEDRO AVE",
            "address_2": "SUITE 120",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782166256",
            "telephone_number": "210-661-5622",
            "fax_number": "210-798-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 MEDICAL DR STE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293342",
            "telephone_number": "210-692-7228",
            "fax_number": "210-692-9671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ WONG",
        "first_name": "ROQUE",
        "middle_name": "ALBERTO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301089787",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "P5965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "324927801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.