NPIMap

Individual provider Active NPI

Lily C Wang, M.D., PHD

  • Pediatric Urology Physician
  • South Portland, ME
National Provider Identifier
1487979878
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
MD26142 Issued in ME
Practice address
100 Brickhill Ave
South Portland, ME 04106-1999
Phone
(207) 773-1728
NPI assigned
Mar 29, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X A155662 CA
Pediatric Urology Physician 2088P0231X 155662 CA
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Urology Physician 2088P0231X MD26142 ME Primary

Addresses

Primary practice location

100 Brickhill Ave
South Portland, ME 04106-1999

Mailing address

100 Brickhill Ave
South Portland, ME 04106-1999
Phone (207) 773-1728

Other practice location 1

282 Washington St
Hartford, CT 06106-3322
Phone (860) 837-6292

Other practice location 2

9300 Valley Children'S Place MB16
Madera, CA 93636-8761
Phone (559) 353-6195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, ME2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190117000960 CA Practitioner - Urology 6901142686 Reassigns benefits to 1 organization
I20221010000533 ME Practitioner - Urology 6901142686 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Columbia University College of Physicians and Surgeons, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

100 Brickhill Ave
South Portland, ME 04106-1999

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

84 Campus Dr
Scarborough, ME 04074-7133
Phone (207) 396-7000

Hospital & facility affiliations

  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
155662CAMDPediatric Urology Physician
A155662CAMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Medical Partners CurrentSince Feb 22, 2023 Accepting new patients
Mainehealth CurrentSince Sep 30, 2022 Accepting new patients
Maine Medical Partners CurrentSince Sep 30, 2022 Accepting new patients
Maine Medical Partners Current Accepting new patients
Mainehealth Current Accepting new patients
Maine Medical Partners CurrentSince Sep 30, 2022 Accepting new patients
Valley Children'S Medical Group CurrentSince Nov 7, 2018 Accepting new patients
Mainehealth CurrentSince Sep 30, 2022 Accepting new patients
Maine Medical Partners Current Accepting new patients
Mainehealth Past Accepting new patients

Locations

9300 Valley Childrens Pl
#5
Madera, CA 93636
Phone (559) 353-5700

9300 Valley Childrens Pl
#16
Madera, CA 93636
Phone (559) 353-6195

1524 McHenry Ave
Ste 550570
Modesto, CA 95350
Phone (209) 572-3880

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

49 Spring St
Scarborough, ME 04074
Phone (207) 883-1414

96 Campus Dr
Ste 2B
Scarborough, ME 04074
Phone (207) 883-3491

100 Brickhill Ave
South Portland, ME 04106
Phone (207) 773-1728

Interoperability endpoints

  • Direct secure messaging: lwang557308@direct.mmc.mainehealth.org

Organizations & group practices 10

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 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1487979878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BRICKHILL AVE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041061999",
            "telephone_number": "207-773-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BRICKHILL AVE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041061999",
            "telephone_number": "207-773-1728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "282 Washington St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061063322",
            "country_code": "US",
            "telephone_number": "860-837-6292",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9300 VALLEY CHILDREN'S PLACE MB16",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "936368761",
            "country_code": "US",
            "telephone_number": "559-353-6195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "LILY",
        "middle_name": "C",
        "credential": "M.D., PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-29",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "CA",
            "license": "A155662",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "CA",
            "license": "155662",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "ME",
            "license": "MD26142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.