NPIMap

Individual provider Active NPI

Pui-Sum Susan Wong, M.D.

  • Internal Medicine Physician
  • Texarkana, TX
National Provider Identifier
1912975111
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L3192 Issued in TX
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Mar 14, 2006
Last updated
Apr 20, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E3038 AR
Internal Medicine Physician 207R00000X L3192 TX Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071231000555 TX Practitioner - Internal Medicine 9739147380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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

Practice addresses (Care Compare)

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E3038ARMDInternal Medicine Physician
L3192TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew 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 CurrentSince Jul 1, 2009 Accepting new patients
Collom & Carney Clinic Association Internal Medicine CurrentSince Jul 1, 2009 Accepting new patients
Collom & Carney Clinic Association 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

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

2602 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-6000

2931 Richmond Rd
Texarkana, TX 75503
Phone (903) 614-3200

5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008

Interoperability endpoints

  • Direct secure messaging: puisum.wong.p1@direct.collom-carney.nextgenshare.com

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 8

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303257600000",
    "number": "1912975111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "PUI-SUM",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2011-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E3038",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L3192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.