NPIMap

Organization Active NPI

George Wang,MD,LLC

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
National Provider Identifier
1972077220
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GEORGE WANG,MD,LLC
Practice address
4001 E Baseline Rd Ste 205
Gilbert, AZ 85234-2743
Phone
(480) 967-6888
Fax
(480) 967-6887
NPI assigned
Jan 18, 2019
Organization subpart
Yes
Parent organization
GEORGE WANG MD, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Authorized official

Name
Cynthia Bryan
Title
Practice Manager
Phone
(480) 967-6888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

4001 E Baseline Rd Ste 205
Gilbert, AZ 85234-2743

Mailing address

2919 S Ellsworth Rd Ste 135
Mesa, AZ 85212-2168
Phone (480) 967-6888

Other names 1

  • AZ Pain Management and Neurology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000242 AZ Part B Supplier - Clinic/Group Practice 6608789755 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mesa, AZ; Gilbert, AZ

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
George Wang MD LLC2 organizations share this tax ID, including this one
Part of
George Wang MD LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2919 S Ellsworth Rd
Ste 135
Mesa, AZ 85212
Phone (480) 357-5780

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1972077220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 S ELLSWORTH RD STE 135",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852122168",
            "telephone_number": "480-967-6888",
            "fax_number": "480-967-6887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 E BASELINE RD STE 205",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342743",
            "telephone_number": "480-967-6888",
            "fax_number": "480-967-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE WANG,MD,LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGE WANG MD, LLC",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "480-967-6888"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZ Pain Management and Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.