Individual provider Active NPI

Mary Wong, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Lakeway, TX
National Provider Identifier
1790171106
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
T6417 Issued in TX
Practice address
100 Medical Pkwy
Lakeway, TX 78738-5621
Phone
(512) 571-5000
NPI assigned
Apr 13, 2015
Last updated
Jul 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MD198522 OR
Student in an Organized Health Care Education/Training Program 390200000X CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X T6417 TX Primary

Addresses

Primary practice location

100 Medical Pkwy
Lakeway, TX 78738-5621

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111

Other practice location 1

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8276

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address mwong1092465@direct.sw.org Direct
Direct Messaging Address mwong1092465@direct.sw.org
Direct Messaging Address mwong1092465@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20220609003047 TX Practitioner - Pathology 2062836455 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Tufts University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

100 Hillcrest Med Blvde
Waco, TX 76712-8897
Phone (254) 202-5800

100 Medical Pkwy
Lakeway, TX 78738-5621
Phone (512) 571-5000

140 Hillcrest Medical Blvd
Waco, TX 76712-8897
Phone (254) 202-8330

150 Hillcrest Medical Blvd
Waco, TX 76712-8897
Phone (254) 202-4000

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

5701 Airport Rd
Temple, TX 76502-7092

800 W Hwy 71
Baylor Scott and White Specialty Clinic
Marble Falls, TX 78654-8602
Phone (830) 201-7100

810 W Hwy 71
Marble Falls, TX 78654-8602
Phone (830) 201-7100

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD198522ORMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Current Accepting new patients
Healthtexas Provider Network CurrentSince Sep 3, 2024 Accepting new patients
Healthtexas Provider Network CurrentSince Sep 3, 2024 Accepting new patients
Scott & White Clinic CurrentSince May 18, 2022 Accepting new patients
Scott & White Clinic CurrentSince May 18, 2022 Accepting new patients
Healthtexas Provider Network Current Accepting new patients
Healthtexas Provider Network Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

5245 W Highway 290
Austin, TX 78735
Phone (512) 509-0100

5330 Overpass Rd
Ste 110
Buda, TX 78610
Phone (737) 999-6200

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

3417 Gaston Ave
Ste 630
Dallas, TX 75246
Phone (469) 800-8900

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

1110 Parker Sq
Flower Mound, TX 75028
Phone (972) 724-1707

100 Medical Pkwy
Lakeway, TX 78738
Phone (512) 206-8100

810 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

2600 E Pflugerville Pkwy
Ste 100
Pflugerville, TX 78660
Phone (512) 654-6100

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

1975 Alpha Dr
#204
Rockwall, TX 75087
Phone (214) 820-7010

300 University Blvd
Bldg A
Round Rock, TX 78665
Phone (512) 509-0100

1901 SW H K Dodgen Loop
Temple, TX 76502
Phone (254) 742-9256

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

100 Hillcrest Medical Blvd
Waco, TX 76712
Phone (254) 202-2000

Interoperability endpoints

  • Direct secure messaging: mwong123189@direct.ohsu.edu

Organizations & group practices 8

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 6

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": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1790171106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787385621",
            "telephone_number": "512-571-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-8276",
            "fax_number": "503-494-2025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-13",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OR",
            "license": "MD198522",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "T6417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwong1092465@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Medical Pkwy",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787385621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwong1092465@direct.sw.org",
            "affiliation": "N",
            "address_1": "100 Medical Pkwy",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787385621",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwong1092465@direct.sw.org",
            "affiliation": "N",
            "address_1": "100 Medical Pkwy",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787385621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakeway, TX

Sources for this page

Verify at the official NPI Registry.