NPIMap

Individual provider Active NPI

Samuel Wisco Ong, M.D.

  • Cardiovascular Disease Physician
  • Crossville, TN
National Provider Identifier
1619991544
Registry record updated Aug 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD37580 Issued in TN
Practice address
49 Cleveland St
Ste. 250
Crossville, TN 38555-9716
Phone
(931) 484-8100
Fax
(931) 707-9135
NPI assigned
Jul 26, 2006
Last updated
Aug 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD37580 TN Primary

Addresses

Primary practice location

49 Cleveland St
Ste. 250
Crossville, TN 38555-9716

Mailing address

49 Cleveland St
Ste. 250
Crossville, TN 38555-9716
Phone (931) 484-8100

Other identifiers 1

IdentifierTypeStateIssuer
P00060241OtherTNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20101026000444 TN Practitioner - Cardiovascular Disease (Cardiology) 2163520388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

49 Cleveland St
Suite 250
Crossville, TN 38555-2856
Phone (931) 484-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.2 of 100Reported as individual
Quality
52.79
Improvement activities
40
Cost
93.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21077OKMDDental Assistant
MD37580TNMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland Heart Clinic, PLLC Cardiovascular Disease CurrentSince Sep 15, 2003 Accepting new patients
Cardiology Clinic of Muskogee, Inc. Cardiovascular Disease Past Accepting new patients
Munson Medical Group Past Accepting new patients
Great Lakes Cardiology, P.C. Cardiovascular Disease Past Accepting new patients

Locations

49 Cleveland St
Ste 250
Crossville, TN 38555
Phone (931) 484-8100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3442/brand/1/csg/61/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312156800000",
    "number": "1619991544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 CLEVELAND ST",
            "address_2": "STE. 250",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385559716",
            "telephone_number": "931-484-8100",
            "fax_number": "931-707-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 CLEVELAND ST",
            "address_2": "STE. 250",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385559716",
            "telephone_number": "931-484-8100",
            "fax_number": "931-707-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONG",
        "first_name": "SAMUEL",
        "middle_name": "WISCO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2011-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "MD37580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00060241",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.