NPIMap

Individual provider Active NPI

Mariko K Wong, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Everett, MA
National Provider Identifier
1497984454
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
269330 Issued in MA
Practice address
103 Garland St
Everett, MA 02149-5066
Phone
(671) 394-7703
Fax
(617) 394-7804
NPI assigned
Jul 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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 ML 60093908 WA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD15008 RI
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 036.129630 IL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 269330 MA Primary

Addresses

Primary practice location

103 Garland St
Everett, MA 02149-5066

Mailing address

103 Garland St
Everett, MA 02149-5066

Other names 1

  • Dr. Mariko Koya Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20170222000207 MA Practitioner - Geriatric Medicine 8820222839 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cambridge Public Health CommissionGroup PAC ID 8921910894, 654 clinicians

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

Hospital & facility affiliations

  • Legacy Lifecare Hospice and Palliative Care Hospice, Chelsea, MA, CCN 221584
  • Cambridge Health Alliance Hospital, Cambridge, MA, CCN 220011
  • Rehabilitation & Nursing Center at Everett (the) Nursing home, Everett, MA, CCN 225300
  • Lighthouse Rehabilitation and Healthcare Center Nursing home, Revere, MA, CCN 225297
  • Katzman Family Center for Living Nursing home, Chelsea, MA, CCN 225451

Merit-based Incentive Payment System (MIPS)

Final score
91.27 of 100Reported as group
Quality
77.51
Promoting interoperability
100
Improvement activities
40
Cost
76.72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ML 60093908WAMDInternal Medicine Physician
036.129630ILMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Public Health Commission CurrentSince Mar 6, 2017 Accepting new patients
Cambridge Public Health Commission Current Accepting new patients
Lighthouse of Revere, Inc. Past Accepting new patients
Lighthouse Operator LLC Past Accepting new patients
Ernc Operating, LLC Past Accepting new patients
Chelsea Jewish Nursing Home, Inc. Past Accepting new patients

Locations

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

Interoperability endpoints

  • Direct secure messaging: mwong81425@direct.challiance.masshiway.net

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
Katzman Family Center for LivingChelsea, MA, CCN 225451 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2017
Apr 1, 2017

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 6

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": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1497984454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 GARLAND ST",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021495066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 GARLAND ST",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "021495066",
            "telephone_number": "671-394-7703",
            "fax_number": "617-394-7804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "MARIKO",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-10",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "ML 60093908",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "RI",
            "license": "MD15008",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036.129630",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "269330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIKO",
            "last_name": "KOYA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Everett, MA

Sources for this page

Verify at the official NPI Registry.