Individual provider Active NPI

Rong Bao, M.D.

  • Internal Medicine Physician
  • Waycross, GA
National Provider Identifier
1861055378
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
90090 Issued in GA
Practice address
1900 Tebeau St
Waycross, GA 31501-6357
Phone
(912) 283-3030
NPI assigned
Apr 19, 2019
Reactivated
Dec 13, 2019
Last updated
Nov 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 90090 GA Primary

Addresses

Primary practice location

1900 Tebeau St
Waycross, GA 31501-6357

Mailing address

1900 Tebeau St
Waycross, GA 31501-6357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20220613001696 GA Practitioner - Internal Medicine 7618355199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1900 Tebeau St
Waycross, GA 31501-6357
Phone (912) 283-3030

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
90090GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Physician Services - Southeast Professional Corporation CurrentSince Jul 1, 2022 Accepting new patients
Southeast Georgia Health Services, L.L.C. Past Accepting new patients

Locations

501 Redmond Rd NW
Rome, GA 30165
Phone (706) 291-0291

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

Organizations & group practices 2

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 3

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": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1861055378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 TEBEAU ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 TEBEAU ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016357",
            "telephone_number": "912-283-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAO",
        "first_name": "RONG",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-19",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "deactivation_date": "2019-12-04",
        "reactivation_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "90090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.