Individual provider Active NPI

Wales R Shao, M.D.

  • Diagnostic Radiology Physician
  • Flushing, NY
National Provider Identifier
1619930732
Registry record updated Nov 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
198977 Issued in NY
Practice address
5645 Main St
Flushing, NY 11355-5045
Phone
(718) 670-1594
Fax
(718) 670-1901
NPI assigned
Apr 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2011

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 198977 NY
Neuroradiology Physician 2085N0700X 198977 NY
Nuclear Radiology Physician 2085N0904X 198977 NY
Diagnostic Radiology Physician 2085R0202X 198977 NY Primary
Therapeutic Radiology Physician 2085R0203X 198977 NY
Vascular & Interventional Radiology Physician 2085R0204X 198977 NY
Diagnostic Ultrasound Physician 2085U0001X 198977 NY

Addresses

Primary practice location

5645 Main St
Flushing, NY 11355-5045

Mailing address

3211 Francis Lewis Blvd
Flushing, NY 11358-1922
Phone (718) 352-9850

Other identifiers 1

IdentifierTypeStateIssuer
01669369MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20060104000430 NY Practitioner - Diagnostic Radiology 3870516990 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of Main Street PCGroup PAC ID 5799677522, 52 clinicians
Main Street Radiology at Bayside LLCGroup PAC ID 5395732671, 56 clinicians

Practice addresses (Care Compare)

21 Ivy Close
Forest Hills, NY 11375-6020
Phone (718) 670-1050

3225 Francis Lewis Blvd
Flushing, NY 11358-1922
Phone (718) 428-1500

5645 Main St
Flushing, NY 11355-5045
Phone (718) 428-1500

Hospital & facility affiliations

  • New York-Presbyterian/Queens Hospital, Flushing, NY, CCN 330055

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
198977NYMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Main Street Radiology at Bayside LLC Diagnostic Radiology CurrentSince Jul 1, 2001 Accepting new patients
Sunset Park Radiology PC Diagnostic Radiology CurrentSince Feb 20, 2024 Accepting new patients
Radiology Associates of Main Street PC Diagnostic Radiology CurrentSince Oct 22, 1997 Accepting new patients
Main Street Radiology at Bayside LLC Diagnostic Radiology CurrentSince Jul 1, 2001 Accepting new patients

Locations

5521 8th Ave
Fl 6
Brooklyn, NY 11220
Phone (718) 928-2588

374 Stockholm St
Brooklyn, NY 11237
Phone (718) 963-6485

3225 Francis Lewis Blvd
Flushing, NY 11358
Phone 61421018851070

3211 Francis Lewis Blvd
Flushing, NY 11358
Phone (718) 352-9850

5645 Main St
Flushing, NY 11355
Phone (718) 670-1435

7206 Northern Blvd
Jackson Heights, NY 11372
Phone (718) 670-1512

16022 Willets Point Blvd
Whitestone, NY 11357
Phone (718) 352-9850

Interoperability endpoints

  • Direct secure messaging: shaowal@direct.nyp.org

Organizations & group practices 4

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 4

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1619930732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 FRANCIS LEWIS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581922",
            "telephone_number": "718-352-9850",
            "fax_number": "718-352-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1594",
            "fax_number": "718-670-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAO",
        "first_name": "WALES",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NY",
            "license": "198977",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NY",
            "license": "198977",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NY",
            "license": "198977",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "198977",
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "NY",
            "license": "198977",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "198977",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "NY",
            "license": "198977",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01669369",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.