Individual provider Active NPI

Jason H Wong, MD

  • Adult Medicine Physician
  • Waltham, MA
National Provider Identifier
1821052242
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
MD0041655 Issued in WA
Practice address
221 Crescent St
Waltham, MA 02453-3475
Phone
(866) 849-0692
Fax
(888) 973-8821
NPI assigned
Apr 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 2021-02364 NC
Adult Medicine Physician 207QA0505X MD0041655 WA Primary
Adult Medicine Physician 207QA0505X DR.0066357 CO
Adult Medicine Physician 207QA0505X TPME5081 FL
Adult Medicine Physician 207QA0505X 35C.000339 OH
Adult Medicine Physician 207QA0505X 86632 SC
Adult Medicine Physician 207QA0505X 49117 AL
Adult Medicine Physician 207QA0505X 63645 AZ
Adult Medicine Physician 207QA0505X U1456 TX
Adult Medicine Physician 207QA0505X 63516 TN

Addresses

Primary practice location

221 Crescent St
Waltham, MA 02453-3475

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Other identifiers 1

IdentifierTypeStateIssuer
8361347MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, NC, TN, TX, CO, AZ, FL, SC, KY, IN10 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 10

Enrollment IDStateProvider typePAC IDDetails
I20040511001757 WA Practitioner - General PracticePractitioner - Family Practice 3375532559 Reassigns benefits to 2 organizations
I20240418004090 NC Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240522000818 TN Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240522004274 TX Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240522004293 CO Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240530002025 AZ Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240530002064 FL Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240614000913 SC Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20240715000998 KY Practitioner - Internal Medicine 3375532559 Reassigns benefits to 1 organization
I20241019000022 IN Practitioner - Family Practice 3375532559 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49117ALMDAdult Medicine Physician
DR.0066357COMDAdult Medicine Physician
35C.000339OHMDAdult Medicine Physician
63516TNMDAdult Medicine Physician
MD0041655WAMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince May 5, 2019 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince May 5, 2019 Accepting new patients
Devoted Medical NC PC CurrentSince Mar 21, 2024 Accepting new patients
Devoted Medical Group of Texas Inc CurrentSince May 16, 2024 Accepting new patients
Kaiser Foundation Health Plan of Washington Current Accepting new patients

Locations

221 Crescent St
Ste 202
Waltham, MA 02453
Phone (617) 958-1611

220 N Main St
Ste 500
Greenville, SC 29601
Phone (347) 294-3414

1201 Fannin St
Ste 262
Houston, TX 77002
Phone (714) 873-6202

140 SW 146th St
Burien, WA 98166
Phone (206) 630-3000

14701 179th Ave SE
Monroe, WA 98272
Phone (360) 794-1409

3030 Limited Ln NW
Olympia, WA 98502
Phone (360) 352-6000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

10452 Silverdale Way NW
Silverdale, WA 98383
Phone (360) 307-7300

209 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 596-3300

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Organizations & group practices 7

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": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1821052242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 CRESCENT ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024533475",
            "telephone_number": "866-849-0692",
            "fax_number": "888-973-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "JASON",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NC",
            "license": "2021-02364",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WA",
            "license": "MD0041655",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CO",
            "license": "DR.0066357",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "TPME5081",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "OH",
            "license": "35C.000339",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "SC",
            "license": "86632",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AL",
            "license": "49117",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AZ",
            "license": "63645",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "U1456",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TN",
            "license": "63516",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8361347",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

Verify at the official NPI Registry.