Individual provider Active NPI

Mariam Philip Korah, MD

  • Radiation Oncology Physician
  • Antioch, CA
National Provider Identifier
1083891543
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
001392 Issued in GA
Practice address
4721 Dallas Ranch Rd
Antioch, CA 94531-8811
Phone
(925) 778-0679
Fax
(925) 778-3567
NPI assigned
Jan 28, 2008
Last updated
Jul 23, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 001392 GA Primary

Addresses

Primary practice location

4721 Dallas Ranch Rd
Antioch, CA 94531-8811

Mailing address

4721 Dallas Ranch Rd
Antioch, CA 94531-8811
Phone (925) 778-0679

Other names 1

  • Dr. Mariam Philip Korah Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20130712000673 CA Practitioner - Radiation Oncology 1456591528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Florida College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Epic CareGroup PAC ID 5890053094, 54 clinicians

Practice addresses (Care Compare)

4721 Dallas Ranch Rd
Antioch, CA 94531-8811
Phone (925) 778-0679

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001392GAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Epic Care CurrentSince Feb 13, 2018 Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
John Muir Health Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients

Locations

4721 Dallas Ranch Rd
Antioch, CA 94531
Phone (925) 676-2600

6380 Clark Ave
Dublin, CA 94568
Phone (925) 277-1900

27204 Calaroga Ave
Hayward, CA 94545
Phone (510) 732-6930

400 Taylor Blvd
Ste 201
Pleasant Hill, CA 94523
Phone (510) 783-6865

355 Lennon Ln
Ste 205
Walnut Creek, CA 94598
Phone (925) 935-0627

Interoperability endpoints

  • Direct secure messaging: mkorah113371@ehr.johnmuirhealth.com

Organizations & group practices 4

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 1

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": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1083891543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 DALLAS RANCH RD",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945318811",
            "telephone_number": "925-778-0679",
            "fax_number": "925-778-3567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 DALLAS RANCH RD",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945318811",
            "telephone_number": "925-778-0679",
            "fax_number": "925-778-3567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORAH",
        "first_name": "MARIAM",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-28",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "GA",
            "license": "001392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIAM",
            "last_name": "KORAH",
            "middle_name": "PHILIP",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Antioch, CA

Sources for this page

Verify at the official NPI Registry.