Individual provider Active NPI

Alice Wang, PA-C

  • Physician Assistant
  • San Clemente, CA
National Provider Identifier
1992210660
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
831 Via Suerte Ste 102
San Clemente, CA 92673-6531
Phone
(949) 364-5600
NPI assigned
Dec 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

831 Via Suerte Ste 102
San Clemente, CA 92673-6531

Mailing address

831 Via Suerte Ste 102
San Clemente, CA 92673-6531
Phone (949) 364-5600

Other practice location 1

17095 Main St
Hesperia, CA 92345-6004
Phone (760) 956-4123

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alicewang@sjhhandhmg.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180117000807 CA Practitioner - Physician Assistant 5991064032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

17043 Main St
Hesperia, CA 92345-6055
Phone (760) 241-6666

19333 Bear Valley Rd
Apple Valley, CA 92308-5149

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

395 W Avenida Vista Hermosa
San Clemente, CA 92672-7720
Phone (949) 304-2117

831 Via Suerte
Suite 102
San Clemente, CA 92673-6531
Phone (949) 364-5600

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health Orange County Home health agency, Anaheim, CA, CCN 057600
  • Providence at Home With Compassus Home Health, Orange County South Home health agency, Irvine, CA, CCN 058238
  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jan 15, 2018 Accepting new patients
Providence Medical Foundation CurrentSince Jan 15, 2018 Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

19333 Bear Valley Rd
Ste 106
Apple Valley, CA 92308
Phone (760) 240-5505

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

17095 Main St
Hesperia, CA 92345
Phone (760) 948-6606

831 Via Suerte
Ste 102
San Clemente, CA 92673
Phone (949) 364-5600

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1992210660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 VIA SUERTE STE 102",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736531",
            "telephone_number": "949-364-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 VIA SUERTE STE 102",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736531",
            "telephone_number": "949-364-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17095 Main St",
            "address_purpose": "LOCATION",
            "city": "Hesperia",
            "state": "CA",
            "postal_code": "923456004",
            "country_code": "US",
            "telephone_number": "760-956-4123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "ALICE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alicewang@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "17095 Main St",
            "city": "Hesperia",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923456004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.