NPIMap

Individual provider Active NPI

Allen Wong, MD

  • Internal Medicine Physician
  • Eagle, ID
National Provider Identifier
1508817214
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M-17388 Issued in ID
Practice address
323 E Riverside Dr Ste 224
Eagle, ID 83616-6865
Phone
(208) 302-6000
Fax
(208) 302-6055
NPI assigned
May 15, 2006
Last updated
Jan 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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 9700162 NC
Internal Medicine Physician 207R00000X M-17388 ID Primary

Addresses

Primary practice location

323 E Riverside Dr Ste 224
Eagle, ID 83616-6865

Mailing address

500 W Fort St
Orange
Boise, ID 83702-4501
Phone (208) 422-1326

Other practice location 1

3330 Siskey Pkwy
Matthews, NC 28105-3222
Phone (704) 316-2127

Other practice location 2

1401 Matthews Township Pkwy Ste 200
Matthews, NC 28105-5403
Phone (704) 384-6901

Other identifiers 2

IdentifierTypeStateIssuer
N00162MedicaidSC
891044WMedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address awong15674@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20250205002573 ID Practitioner - Internal Medicine 4981794229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3025 W Cherry LN
Meridian, ID 83642-8531

323 E Riverside Dr
Eagle, ID 83616-6865
Phone (208) 302-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9700162NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Internal Medicine CurrentSince Mar 1, 2025 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

323 E Riverside Dr
Ste 224
Eagle, ID 83616
Phone (208) 302-6000

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: awong15674@direct.novanthealth.org
  • Direct secure messaging: awong3899808@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1508817214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "address_2": "ORANGE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024501",
            "telephone_number": "208-422-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E RIVERSIDE DR STE 224",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166865",
            "telephone_number": "208-302-6000",
            "fax_number": "208-302-6055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3330 Siskey Pkwy",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281053222",
            "country_code": "US",
            "telephone_number": "704-316-2127",
            "fax_number": "704-316-2136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Matthews Township Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281055403",
            "country_code": "US",
            "telephone_number": "704-384-6901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9700162",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-17388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N00162",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891044W",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awong15674@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "3330 Siskey Pkwy",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281053222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.