Active NPI
Adam Jens Wong, AU.D. CCC-A
- Audiologist
- Petoskey, MI
National Provider Identifier
1770813289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 1601000547
- Practice address
- 2206 Mitchell Park Dr Ste 13B
Petoskey, MI 49770-8674 - Phone
- (517) 862-3043
- NPI assigned
- Jan 5, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000547 | MI | Primary |
Addresses
Primary practice location
2206 Mitchell Park Dr Ste 13B
Petoskey, MI 49770-8674
Mailing address
2206 Mitchell Park Dr Ste 13B
Petoskey, MI 49770-8674
Phone (517) 862-3043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100910000787 | MI | Practitioner - Qualified Audiologist | 9133244312 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615334400000",
"number": "1770813289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2206 MITCHELL PARK DR STE 13B",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497708674",
"telephone_number": "517-862-3043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2206 MITCHELL PARK DR STE 13B",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497708674",
"telephone_number": "517-862-3043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "ADAM",
"middle_name": "JENS",
"name_prefix": "Dr.",
"credential": "AU.D. CCC-A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-05",
"last_updated": "2021-03-10",
"certification_date": "2021-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MI",
"license": "1601000547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.