Individual provider Active NPI

Peter Hoang

  • Sports Medicine (Family Medicine) Physician
  • Chicago, IL
National Provider Identifier
1740939628
Registry record updated Jun 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
036.174382 Issued in IL
Practice address
1611 W Harrison St Ste 400
Chicago, IL 60612-4861
Phone
(312) 432-2300
NPI assigned
Mar 20, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A190873 CA
Sports Medicine (Family Medicine) Physician 207QS0010X 036.174382 IL Primary

Addresses

Primary practice location

1611 W Harrison St Ste 400
Chicago, IL 60612-4861

Mailing address

200 S Manchester Ave Ste 835
Orange, CA 92868-3213
Phone (714) 480-2440

Other practice location 1

200 S Manchester Ave Ste 835
Orange, CA 92868-3213
Phone (714) 480-2440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230526001375 CA Order and Referring Only - Family PracticePractitioner - Family Practice 4082071592

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A190873CAMDFamily Medicine Physician
036.174382ILMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: peter.hoang.1@12576.direct.athenahealth.com

Organizations & group practices 1

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": "1647734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751068800000",
    "number": "1740939628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MANCHESTER AVE STE 835",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683213",
            "telephone_number": "714-480-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 400",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "312-432-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 S Manchester Ave Ste 835",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683213",
            "country_code": "US",
            "telephone_number": "714-480-2440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOANG",
        "first_name": "PETER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-20",
        "last_updated": "2025-06-28",
        "certification_date": "2025-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A190873",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036.174382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.