Active NPI
John Kevin Koch, MD
- Surgery Physician
- Vienna, WV
National Provider Identifier
1104824044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 19553
- Practice address
- 800 Grand Central Mall
Suite 2
Vienna, WV 26105-4100 - Phone
- (304) 865-4350
- Fax
- (304) 865-4348
- NPI assigned
- Jul 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 19553 | WV | Primary |
Addresses
Primary practice location
800 Grand Central Mall
Suite 2
Vienna, WV 26105-4100
Mailing address
800 Grand Central Mall
Suite 2
Vienna, WV 26105-4100
Phone (304) 865-4350
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0011154000 | Medicaid | WV | |
| 2197448 | Medicaid | OH | |
| 311599387-00 | Other | OH | WORKERS COMP |
| 201655 | Other | FEDERAL BLACK LUNG | |
| 311599387003 | Other | WV | MOUTAIN STATE BCBS |
| 9298571 | Other | WV | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19553 | WV | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1104824044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 GRAND CENTRAL MALL",
"address_2": "SUITE 2",
"city": "VIENNA",
"state": "WV",
"postal_code": "261054100",
"telephone_number": "304-865-4350",
"fax_number": "304-865-4348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 GRAND CENTRAL MALL",
"address_2": "SUITE 2",
"city": "VIENNA",
"state": "WV",
"postal_code": "261054100",
"telephone_number": "304-865-4350",
"fax_number": "304-865-4348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCH",
"first_name": "JOHN",
"middle_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-13",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WV",
"license": "19553",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011154000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2197448",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP",
"identifier": "311599387-00",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG",
"identifier": "201655",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOUTAIN STATE BCBS",
"identifier": "311599387003",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "9298571",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vienna, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.