Pui-Sum Susan Wong, M.D.
Individual provider Active NPI Internal Medicine Physician · Texarkana, TX
NPI 1912975111 · NPPES record last updated Apr 20, 2011
Key facts
- NPI
- 1912975111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- L3192 (TX)
- Practice address
- 5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766 - Phone
- (903) 614-3000
- Fax
- (903) 614-3525
- NPI assigned
- Mar 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Texas Medical School at Houston, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Collom and Carney Clinic Association
Practice addresses (Care Compare)
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000
Hospital & facility affiliations
- Onesource Home Care Inc
- Chambers Home Health Agency
- Christus Homecare - St Michael
- Enhabit Home Health
- Elite Home Health
- Christus St Michael Health System
- Christus Mother Frances Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071231000555 | TX | Practitioner - Internal Medicine | 9739147380 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E3038 | AR | MD | Internal Medicine Physician |
| L3192 | TX | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collom & Carney Clinic Association | Current | Accepting new patients | |
| Collom & Carney Clinic Association | Current | Accepting new patients | |
| Collom & Carney Clinic Association | Current |
Accepting new patients | |
| Collom & Carney Clinic Association | Current | Accepting new patients | |
| Collom & Carney Clinic Association | Current | Accepting new patients | |
| Collom & Carney Clinic Association | Internal Medicine | Current |
Accepting new patients |
| Collom and Carney Clinic Association | Past | Accepting new patients | |
| Collom and Carney Clinic Association | Past | Accepting new patients |
Locations
1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365
5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008
2931 Richmond Rd
Texarkana, TX 75503
Phone (903) 614-3200
2602 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-6000
2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000
Interoperability endpoints
- puisum.wong.p1@direct.collom-carney.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | E3038 | AR | |
| Internal Medicine Physician | 207R00000X | L3192 | TX | Yes |
Addresses
Primary practice location
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Mailing address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8AN222 | Other | TX | BCBS TEXAS |
| 145610001 | Medicaid | AR | |
| 200124670A | Medicaid | OK | |
| 147257303 | Medicaid | TX | |
| P00473270 | Other | TX | RR MEDICARE |
Other providers in Texarkana, TX
- Stephanie Winfield
- Lexius Winfrey
- Kellie Dawn Winn
- Winnie-Stowell Hospital District
- Joseph Sean Womack
- Sean Wood
- Latisea Woodberry
- Walter W Woodruff
- Lashawn L Woods
- Jeffrey E. Woosley
All providers in Texarkana, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.