NPIMap

Individual provider Active NPI

Johnny Fong, MD

  • Emergency Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1962955526
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20152 Issued in NV
Practice address
3186 S Maryland Pkwy
Las Vegas, NV 89109-2317
Phone
(702) 984-6888
NPI assigned
Aug 1, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 20152 NV Primary

Addresses

Primary practice location

3186 S Maryland Pkwy
Las Vegas, NV 89109-2317

Mailing address

5575 Simmons St
Suite 1 Unit 563
N Las Vegas, NV 89031-9008

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
I20201207000687 NV Practitioner - Emergency Medicine 9436575636 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, San Francisco School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shadow Emergency Physicians PLLCGroup PAC ID 2860667375, 105 clinicians

Practice addresses (Care Compare)

3186 S Maryland Pkwy
Las Vegas, NV 89109-2317
Phone (702) 731-8585

620 Shadow LN
Las Vegas, NV 89106-4119
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20152NVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Sep 1, 2021 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Sep 1, 2021 Accepting new patients
Fremont Emergency Services Scherr LTD Emergency Medicine CurrentSince Oct 15, 2020 Accepting new patients
Fremont Emergency Services Scherr LTD Emergency Medicine Current Accepting new patients
Fremont Emergency Services Scherr LTD Emergency Medicine Past Accepting new patients

Locations

1050 W Galleria Dr
Henderson, NV 89011
Phone (702) 723-4124

3186 S Maryland Pkwy
Ste 410
Las Vegas, NV 89109

3325 S Fort Apache Rd
Las Vegas, NV 89117
Phone (702) 962-0500

9300 W Sunset Rd
Las Vegas, NV 89148
Phone (702) 880-2100

10770 Las Vegas Blvd S
Las Vegas, NV 89183
Phone (702) 916-9002

3100 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 225-5025

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

3186 S Maryland Pkwy
Las Vegas, NV 89109
Phone (702) 731-8000

7207 Aliante Pkwy
North Las Vegas, NV 89084
Phone (702) 962-5100

Organizations & group practices 5

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1470009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1962955526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5575 SIMMONS ST",
            "address_2": "SUITE 1 UNIT 563",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "890319008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3186 S MARYLAND PKWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092317",
            "telephone_number": "702-984-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "JOHNNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-01",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "20152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.