NPIMap

Individual provider Active NPI

Jim Wang, DO

  • Family Medicine Physician
  • Pahrump, NV
National Provider Identifier
1962614388
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
907 Issued in NV
Practice address
2210 E Calvada Blvd
Pahrump, NV 89048-5804
Phone
(775) 727-6400
Fax
(775) 727-7543
NPI assigned
May 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 907 NV Primary

Addresses

Primary practice location

2210 E Calvada Blvd
Pahrump, NV 89048-5804

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 877-5199

Other identifiers 2

IdentifierTypeStateIssuer
P00928524OtherNVRR MEDICARE
1962614388MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20041112001179 NV Practitioner - Family Practice 6709850407 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Group II Rhodes P CGroup PAC ID 4981687779, 296 clinicians

Practice addresses (Care Compare)

420 N Nellis Blvd
Las Vegas, NV 89110-5364
Phone (702) 579-3253

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Group II Rhodes P C CurrentSince Jun 3, 2019 Accepting new patients
Southwest Medical Associates, Inc CurrentSince Feb 7, 2011 Accepting new patients
Optum Medical Group Rhodes P C Current Accepting new patients
Linda L. Johnson MD, LTD Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients

Locations

300 E Lake Mead Pkwy
Henderson, NV 89015
Phone (702) 435-4301

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

2210 E Calvada Blvd
Pahrump, NV 89048
Phone (775) 727-6400

Interoperability endpoints

  • Direct secure messaging: jwang119342@westdirect.optum.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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1178409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1962614388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-877-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 E CALVADA BLVD",
            "city": "PAHRUMP",
            "state": "NV",
            "postal_code": "890485804",
            "telephone_number": "775-727-6400",
            "fax_number": "775-727-7543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JIM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-06",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00928524",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962614388",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pahrump, NV

Sources for this page

Verify at the official NPI Registry.