Andrew Manongdo Wang, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301086112 Issued in MI

Practice address

2848 Niles Rd
Saint Joseph, MI 49085-3352

Phone

(269) 428-3300

Fax

(269) 428-5005

NPI assigned

Jun 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Rush Medical College of Rush University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Eye Care PCGroup PAC ID 8426091992, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Great Lakes Eye Care PC

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1922002708
  Medicare reassignment Care Compare group
• Great Lakes Eye Care, P.C.

  • Durable Medical Equipment & Medical Supplies
  • South Haven, MI
  • NPI 1114058369
  NPD

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1992701098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "570 Broadway St",
            "address_purpose": "LOCATION",
            "city": "South Haven",
            "state": "MI",
            "postal_code": "490901420",
            "country_code": "US",
            "telephone_number": "269-637-3101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "ANDREW",
        "middle_name": "MANONGDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301086112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4741387",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4826671",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Angela Walker
• John W Walker, MD
• Rebecca Walter, NP
• Amy Walton, COTA
• Michael S Wang, MD
• Edward Horace Ward, DDS
• Michael Timothy Ward, D.D.S.
• Robert Campbell Ward III, D.O.
• Michael Raymond Warmoth, MD

• Ophthalmology Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.