Individual provider Active NPI

Andrew Ginn Bong Young, M.D.

  • Ophthalmology Physician
  • Providence, RI
National Provider Identifier
1659310738
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD16400 Issued in RI
Practice address
1 Hoppin St Ste 202
Providence, RI 02903-4141
Phone
(401) 444-6551
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD16400 RI Primary
Glaucoma Specialist (Ophthalmology) Physician 207WX0009X MD16400 RI

Addresses

Primary practice location

1 Hoppin St Ste 202
Providence, RI 02903-4141

Mailing address

4 La Linda Dr
Long Beach, CA 90807-3306
Phone (310) 415-3676

Other identifiers 1

IdentifierTypeStateIssuer
00A898610MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050705000447 CA Practitioner - Ophthalmology 7012953730 Reassigns benefits to 1 organization
I20181126001761 RI Practitioner - Ophthalmology 7012953730 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital Ophthalmology CurrentSince Jan 1, 2019 Accepting new patients
Rhode Island Hospital CurrentSince Jan 1, 2019 Accepting new patients
Kevin Tan, MD and Productions, Inc Ophthalmology CurrentSince Jan 20, 2021 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jan 1, 2019 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jan 1, 2019 Accepting new patients

Locations

360 Post St
Ste 1005
San Francisco, CA 94108
Phone (415) 982-2020

595 Buckingham Way
Ste 448
San Francisco, CA 94132
Phone (415) 564-1060

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1 Hoppin St
Ste 202
Providence, RI 02903
Phone (401) 444-6551

1 Hoppin St
Ste 200
Providence, RI 02903
Phone (401) 444-5509

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1659310738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 LA LINDA DR",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073306",
            "telephone_number": "310-415-3676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOPPIN ST STE 202",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034141",
            "telephone_number": "401-444-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ANDREW",
        "middle_name": "GINN BONG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "RI",
            "license": "MD16400",
            "primary": true
        },
        {
            "code": "207WX0009X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Glaucoma Specialist",
            "state": "RI",
            "license": "MD16400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A898610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.