BRIAN WONG
NPI 1124474960
Pediatrics in Eagle, ID

Q: What is Brian Wong's NPI number?

The NPI number for Brian Wong is 1124474960. It was assigned to this individual provider in the NPPES registry on May 11, 2016.

Q: What is Brian Wong's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Brian Wong was last updated on June 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 11, 2016PECOS Enrolled

3217 W BAVARIA ST, EAGLE, ID 83616(208) 302-6200(208) 302-6245 Get Directions Write a Review

NPPES record last updated: June 2, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 2, 2025, Jun 15, 2019, Jun 4, 2019 and 1 more (4 updates tracked since 2016).

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About Brian Wong NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRIAN WONG (NPI 1124474960) is an individual pediatrics provider in Eagle, Idaho, licensed in Idaho (M-14689) and active in the NPI registry since May 2016. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1124474960

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameBRIAN WONG

Location Address3217 W BAVARIA STEagle, ID 83616-5171

Mailing AddressPo Box 190930Boise, ID 83719-0930 · (208) 367-5170

Phone(208) 302-6200

Fax(208) 302-6245

Sole ProprietorNo

Enumeration DateMay 11, 2016

Last NPPES UpdateJune 2, 20254 updates tracked since enumeration

NPPES CertifiedJune 2, 2025

✔ NPI 1124474960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in ID · M-14689

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

3217 W BAVARIA ST, Eagle, ID 83616

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Secondary Practice Locations 2

Location 111234 Anderson St, GME Office Westerly Suite CLoma Linda, CA 92354-2804 · Phone (909) 558-4174

Location 23653 N Locust Grove RdMeridian, ID 83646-5924 · Phone (208) 338-6437

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brian Wong is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83616 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.13 typical visit price

range $52.44 – $160.17

Typical copayment $20.28 (range $13.11 – $40.04)

Most-billed visit code 99203

Established Patient

$93.26 typical visit price

range $16.68 – $130.93

Typical copayment $23.31 (range $4.17 – $32.73)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID J KELLY MD

Family Medicine