NPIMap

Individual provider Active NPI

Edward Wang, MD

  • Urology Physician
  • San Jose, CA
National Provider Identifier
1972558666
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
G54057 Issued in CA
Practice address
175 N Jackson Ave Ste 206
San Jose, CA 95116-1909
Phone
(669) 214-2599
Fax
(669) 214-2766
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X G54057 CA Primary

Addresses

Primary practice location

175 N Jackson Ave Ste 206
San Jose, CA 95116-1909

Mailing address

1091 Hidden Oaks Dr
Bulverde, TX 78163-3050
Phone (707) 446-9393

Other identifiers 1

IdentifierTypeStateIssuer
00G540570MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.wangurology.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090930000684 CA Practitioner - Urology 9638215916 Reassigns benefits to 1 organization
Practice locations: San Jose, CA

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Chicago College of Medicine and Surgery, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

175 N Jackson Ave
Suite 206
San Jose, CA 95116-1909
Phone (669) 213-6231

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G54057CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group Current Accepting new patients
Northbay Healthcare Group CurrentSince Mar 1, 2011 Accepting new patients
O'Connor Hospital Past Accepting new patients
El Camino Hospital Past Accepting new patients

Locations

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

1860 Pennsylvania Ave
Ste 200
Fairfield, CA 94533
Phone (707) 427-5211

175 N Jackson Ave
Ste 206
San Jose, CA 95116
Phone (408) 259-7282

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: ewang149906@santaclaravalley.direct-ci.net

Organizations & group practices 4

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 4

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1972558666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1091 HIDDEN OAKS DR",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781633050",
            "telephone_number": "707-446-9393",
            "fax_number": "707-455-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N JACKSON AVE STE 206",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161909",
            "telephone_number": "669-214-2599",
            "fax_number": "669-214-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "G54057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G540570",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.wangurology.com",
            "affiliation": "N",
            "endpointDescription": "www.wangurology.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "175 N Jackson Ave Ste 206",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951161909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.