Individual provider Active NPI

Wayne P Tongco, MD

  • Urology Physician
  • Johnson City, TN
National Provider Identifier
1609830504
Registry record updated Apr 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD36058 Issued in TN
Practice address
2340 Knob Creek Rd
Suite 720
Johnson City, TN 37604-2100
Phone
(423) 926-6112
Fax
(423) 434-0278
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD36058 TN Primary

Addresses

Primary practice location

2340 Knob Creek Rd
Suite 720
Johnson City, TN 37604-2100

Mailing address

2340 Knob Creek Rd
Suite 720
Johnson City, TN 37604-2100
Phone (423) 926-6112

Other identifiers 1

IdentifierTypeStateIssuer
3875502MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101025001176 TN Practitioner - Urology 4284784323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

2340 Knob Creek Rd
Suite 720
Johnson City, TN 37604-2977
Phone (423) 926-6112

240 Medical Park Blvd
Bristol, TN 37620-7347

240 Medical Park Blvd
Suite 2600
Bristol, TN 37620-7355
Phone (423) 990-5495

322 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 217-1360

350 Steeles Rd
Unit 1
Bristol, TN 37620-9532
Phone (423) 844-4925

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD36058TNMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holston Medical Group PC CurrentSince Feb 1, 2023 Accepting new patients
Johnson City Urological Clinic, P.C. CurrentSince Jan 1, 2016 Accepting new patients
Urology San Antonio P a Urology Past Accepting new patients

Locations

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

2340 Knob Creek Rd
Ste 720
Johnson City, TN 37604
Phone (423) 926-6112

Interoperability endpoints

  • Direct secure messaging: waynetongco@jcuc.medalliesdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1609830504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 KNOB CREEK RD",
            "address_2": "SUITE 720",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042100",
            "telephone_number": "423-926-6112",
            "fax_number": "423-434-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 KNOB CREEK RD",
            "address_2": "SUITE 720",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042100",
            "telephone_number": "423-926-6112",
            "fax_number": "423-434-0278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TONGCO",
        "first_name": "WAYNE",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "MD36058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3875502",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.