NPIMap

Organization Active NPI

Koinonia Primary Care Inc

  • Clinic/Center
  • Albany, NY
National Provider Identifier
1023389533
Registry record updated Jan 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KOINONIA PRIMARY CARE INC
Practice address
553 Clinton Ave
Albany, NY 12206-2738
Phone
(518) 689-0282
Fax
(518) 689-0283
NPI assigned
Jan 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2012

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

Authorized official

Name
Dr. Robert John Paeglow, M.D.NPI 1568576379
Title
President
Phone
(518) 689-0282

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NY Primary

Addresses

Primary practice location

553 Clinton Ave
Albany, NY 12206-2738

Mailing address

553 Clinton Ave
Albany, NY 12206-2738
Phone (518) 689-0282

Other names 1

  • Koinonia Primary Medical Care PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130403000334 NY Part B Supplier - Clinic/Group Practice 6901041425 Receives reassigned benefits from 7 practitioners
Practice locations: Albany, NY

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EBHGAA

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326672000000",
    "number": "1023389533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 CLINTON AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122062738",
            "telephone_number": "518-689-0282",
            "fax_number": "518-689-0283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 CLINTON AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122062738",
            "telephone_number": "518-689-0282",
            "fax_number": "518-689-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOINONIA PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-16",
        "last_updated": "2012-01-16",
        "status": "A",
        "authorized_official_last_name": "PAEGLOW",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-689-0282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koinonia Primary Medical Care PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.