Individual provider Active NPI

Michelle V Wong, D.O.

  • Gastroenterology Physician
  • Fairhaven, MA
National Provider Identifier
1679912539
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
268676 Issued in MA
Practice address
208 Mill Rd
Fairhaven, MA 02719-5208
Phone
(508) 973-2661
Fax
(508) 973-0314
NPI assigned
Jun 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 268676 MA Primary

Addresses

Primary practice location

208 Mill Rd
Fairhaven, MA 02719-5208

Mailing address

200 Mill Rd Ste 180
Fairhaven, MA 02719-5255
Phone (508) 973-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwong52949@direct.southcoast.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20161005000856 MA Practitioner - GastroenterologyPractitioner - Internal Medicine 5799073896 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

101 Page St
New Bedford, MA 02740-3464
Phone (508) 973-5919

1030 President Ave
Fall River, MA 02720-5923

206 Mill Rd
Fairhaven, MA 02719-5208
Phone (508) 973-3000

208 Mill Rd
Fairhaven, MA 02719-5208
Phone (508) 758-3781

363 Highland Ave
Fall River, MA 02720-3703
Phone (508) 973-5919

534 Prospect St
Fall River, MA 02720-5281
Phone (508) 973-7766

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy149
Upper gastrointestinal (GI) endoscopy for acid reflux100

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. Internal Medicine CurrentSince Aug 1, 2020 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Aug 1, 2020 Accepting new patients
Southcoast Physicians Group, Inc. Internal Medicine Current Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

208 Mill Rd
Fairhaven, MA 02719
Phone (508) 758-3781

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

Interoperability endpoints

  • Direct secure messaging: mwong52949@direct.southcoast.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1679912539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD STE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195255",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MILL RD",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195208",
            "telephone_number": "508-973-2661",
            "fax_number": "508-973-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "MICHELLE",
        "middle_name": "V",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-24",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "268676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwong52949@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "208 Mill Rd",
            "city": "Fairhaven",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027195208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairhaven, MA

Sources for this page

Verify at the official NPI Registry.