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KAITLYN ELIZABETH ELLIS WONG M.D.
NPI 1790006773
Surgery - Pediatric Surgery in Worcester, MA

Active since June 14, 2010PECOS Enrolled
55 LAKE AVE N, WORCESTER, MA 01655(508) 856-2138(774) 443-2043 Get Directions Write a Review

NPPES record last updated: December 6, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 6, 2023, Oct 12, 2021 (2 updates tracked since 2021).

About Kaitlyn Elizabeth Ellis Wong M.d. NPPES

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

KAITLYN ELIZABETH ELLIS WONG M.D. (NPI 1790006773) is an individual pediatric surgery provider in Worcester, Massachusetts, licensed in Massachusetts (287610) and active in the NPI registry since June 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790006773
Entity TypeIndividualFemale
Primary Taxonomy2086S0120X
Provider Legal NameKAITLYN ELIZABETH ELLIS WONGCredential: M.D.
Location Address55 LAKE AVE NWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348
Phone(508) 856-2138
Fax(774) 443-2043
Sole ProprietorNo
Enumeration DateJune 14, 2010
Last NPPES UpdateDecember 6, 20232 updates tracked since enumeration
NPPES CertifiedDecember 6, 2023
✔ NPI 1790006773 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0120X
License✔ Licensed in MA · 287610
Definition
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Also ListedSurgeryTaxonomy 208600000X · License 287610 (MA)
55 LAKE AVE N, Worcester, MA 01655
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Other Names 1

Former Name (1)Kaitlyn Elizabeth Ellis M.d.

Other Identifiers 1

Medicaid110110902AMA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kaitlyn Elizabeth Ellis Wong M.d. 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.

Medicare Billing Reassignment

Medicare enrollment records show Kaitlyn Wong reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Umass Memorial Medical Group Inc
Same address
Internal Medicine
55 LAKE AVE N
Worcester, MA 01655
  • Reassigned Medicare billing, Massachusetts enrollment
  • 2,902 clinicians in this Medicare group
NPI 1760445373 (508) 334-1000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

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

HILLARY R. IRONS MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
MS. EILEEN A. DUHAMEL NP
Nurse Practitioner
55 LAKE AVE N, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-2710
EWA HRYNISZYN CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
HELEN COPSEY PA-C
Physician Assistant
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
DR. ADEPEJU GBADEBO CHAMPION M.D.
Internal Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-2731
SOWMYA KORAPATI
Internal Medicine (Hematology & Oncology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-3550
LAYLA FAKHRZADEH M.D.
Anesthesiology
55 LAKE AVE N, ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
YOONYIE CHO M.D.
Anesthesiology
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kaitlyn Wong's NPI number?

The NPI number for Kaitlyn Wong is 1790006773. It was assigned to this individual provider in the NPPES registry on June 14, 2010. The provider is also known as Kaitlyn Elizabeth Ellis M.D..

Where is Kaitlyn Wong located?

Kaitlyn Wong practices at 55 Lake Ave N, Worcester, MA 01655. The listed phone number is (508) 856-2138.

What is Kaitlyn Wong's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.

Is Kaitlyn Wong enrolled in Medicare?

Yes. Kaitlyn Wong is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kaitlyn Wong's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kaitlyn Wong reassigns Medicare benefits to Umass Memorial Medical Group Inc (Worcester, MA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kaitlyn Wong's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kaitlyn Wong was last updated on December 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.