Individual provider Active NPI

Abhijeet V Koli, MD

  • Cardiovascular Disease Physician
  • Georgetown, TX
National Provider Identifier
1023064656
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
N7294 Issued in TX
Practice address
1900 Scenic Dr Ste 3308
Georgetown, TX 78626-7876
Phone
(512) 869-2566
Fax
(512) 869-7434
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036123894 IL
Cardiovascular Disease Physician 207RC0000X MD15847 HI
Cardiovascular Disease Physician 207RC0000X N7294 TX Primary

Addresses

Primary practice location

1900 Scenic Dr Ste 3308
Georgetown, TX 78626-7876

Mailing address

1900 Scenic Dr Ste 3308
Georgetown, TX 78626-7876
Phone (512) 869-2566

Other identifiers 1

IdentifierTypeStateIssuer
1016296350001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akoli36963@epiccwdv.hcadirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20180823001344 TX Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4082711494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Texas Medical School at San Antonio, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Davids Heart and Vascular PLLCGroup PAC ID 7012821879, 197 clinicians

Practice addresses (Care Compare)

1900 Scenic Dr
Suite 3308
Georgetown, TX 78626-7876
Phone (512) 869-2566

Hospital & facility affiliations

  • St David'S Medical Center Hospital, Austin, TX, CCN 450431
  • Round Rock Medical Center Hospital, Round Rock, TX, CCN 450718
  • Baylor Scott & White Medical Center - Round Rock Hospital, Round Rock, TX, CCN 670034

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036123894ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Davids Heart & Vascular, PLLC Cardiovascular Disease CurrentSince Aug 20, 2018 Accepting new patients

Locations

3801 N Lamar Blvd
#300
Austin, TX 78756
Phone (512) 206-3600

1900 Scenic Dr
Ste 3308
Georgetown, TX 78626
Phone (512) 244-2263

Interoperability endpoints

  • Direct secure messaging: akoli36963@epiccwdv.hcadirect.net
  • Direct secure messaging: 2560-koli-abhijeet@direct.leadingreach.com

Organizations & group practices 1

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 3

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1023064656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SCENIC DR STE 3308",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267876",
            "telephone_number": "512-869-2566",
            "fax_number": "512-869-7434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SCENIC DR STE 3308",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786267876",
            "telephone_number": "512-869-2566",
            "fax_number": "512-869-7434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLI",
        "first_name": "ABHIJEET",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036123894",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "HI",
            "license": "MD15847",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "N7294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016296350001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akoli36963@epiccwdv.hcadirect.net",
            "affiliation": "N",
            "address_1": "1900 Scenic Dr Ste 3308",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786267876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.