Individual provider Active NPI

Alla Roman Koorn, M.D.

  • Anesthesiology Physician
  • Stamford, CT
National Provider Identifier
1053448589
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
041678 Issued in CT
Practice address
30 Shelburne Rd
Stamford, CT 06902-3628
Phone
(203) 276-7000
NPI assigned
Feb 28, 2007
Last updated
Jul 15, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 041678 CT Primary

Addresses

Primary practice location

30 Shelburne Rd
Stamford, CT 06902-3628

Mailing address

1055 Washington Blvd
Suite 440
Stamford, CT 06901-2216
Phone (203) 348-2614

Other identifiers 1

IdentifierTypeStateIssuer
001416785MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20050215000734 CT Practitioner - Anesthesiology 3072565381 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

24 Hospital Ave
Danbury, CT 06810-6099
Phone (203) 739-7118

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041678CTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stamford Anesthesiology Services, PC Anesthesiology CurrentSince Jan 2, 2005 Accepting new patients
Nuvance Health Medical Practice CT, Inc. Anesthesiology CurrentSince Feb 15, 2017 Accepting new patients
Gotham Medical Services Anesthesiology Past Accepting new patients

Locations

14 Research Dr
Bethel, CT 06801

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

21 Elm St
New Milford, CT 06776
Phone (860) 210-5000

1 Hospital Plz
Stamford, CT 06902
Phone (203) 276-4925

1055 Washington Blvd
Ste 440
Stamford, CT 06901
Phone (203) 348-2614

32 Strawberry Hill Ct
Stamford, CT 06902
Phone (203) 276-2000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1053448589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 WASHINGTON BLVD",
            "address_2": "SUITE 440",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069012216",
            "telephone_number": "203-348-2614",
            "fax_number": "206-325-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SHELBURNE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069023628",
            "telephone_number": "203-276-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOORN",
        "first_name": "ALLA",
        "middle_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "041678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001416785",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

Verify at the official NPI Registry.