NPIMap

Organization Active NPI

Stanislaus Cardiology Group

  • Specialist
  • Modesto, CA
National Provider Identifier
1902828841
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
FNP 30072 Issued in CA
Legal business name
STANISLAUS CARDIOLOGY GROUP
Practice address
3621 Forest Glenn Dr
Modesto, CA 95355-1339
Phone
(209) 521-9661
Fax
(209) 521-9307
NPI assigned
Jul 23, 2006
Last updated
Apr 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

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

Authorized official

Name
Mr. Kent Hon-Wah Wong, M.D.NPI 1386628212
Title
Partner
Phone
(209) 521-9661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X FNP 30072 CA Primary

Addresses

Primary practice location

3621 Forest Glenn Dr
Modesto, CA 95355-1339

Mailing address

3621 Forest Glenn Dr
Modesto, CA 95355-1339
Phone (209) 521-9661

Other identifiers 1

IdentifierTypeStateIssuer
1902828841MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050712001288 CA Part B Supplier - Clinic/Group Practice 2264468008 Receives reassigned benefits from 8 practitioners
Practice locations: Modesto, CA

National Provider Directory

National Provider Directory

Locations

1401 Spanos Ct
Ste 230
Modesto, CA 95355
Phone (209) 521-9661

3621 Forest Glenn Dr
Modesto, CA 95355
Phone (209) 521-7411

654 Lyell Dr
Ste A
Modesto, CA 95356
Phone (209) 521-9661

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1022

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1902828841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 FOREST GLENN DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551339",
            "telephone_number": "209-521-9661",
            "fax_number": "209-521-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 FOREST GLENN DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551339",
            "telephone_number": "209-521-9661",
            "fax_number": "209-521-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANISLAUS CARDIOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "HON-WAH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "209-521-9661",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "FNP 30072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902828841",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.

Verify at the official NPI Registry.