Stephen A Koscherak, PHD
Individual provider Active NPI Clinical Psychologist · Southwest Harbor, ME
NPI 1144290941 · NPPES record last updated Mar 25, 2013
Key facts
- NPI
- 1144290941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 0042341 (NY)
- Practice address
- 16 Community LN
Southwest Harbor, ME 04679-4273 - Phone
- (207) 244-5630
- Fax
- (207) 244-4418
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.58 of 100
- Quality
- 83.17
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091124000189 | ME | Practitioner - Clinical Psychologist | 8527019355 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0042341 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mount Desert Island Hospital | Current |
Accepting new patients | |
| Mount Desert Island Hospital | Current |
Accepting new patients | |
| Anthony F Bongiovanni | Clinical | Past | Accepting new patients |
Locations
10 Wayman Ln
Bar Harbor, ME 04609
Phone (207) 288-5082
322 Main St
Bar Harbor, ME 04609
Phone (207) 288-5082
16 Community Ln
Southwest Harbor, ME 04679
Phone (207) 244-5630
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/b5eba017-85d4-4b6c-a2f0-9b2c7b0c38dd/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0042341 | NY | Yes |
Addresses
Primary practice location
16 Community LN
Southwest Harbor, ME 04679-4273
Mailing address
10 Wayman LN
Bar Harbor, ME 04609-1625
Phone (207) 288-5081
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790764512-009 | Medicaid | ME |
Other providers in Southwest Harbor, ME
- Kari Collins Guillen
- Tanya Hanke
- Michael A Heniser
- Monica Jones
- Susan R Kirkpatrick
- Julian P Kuffler
- Daniel Enrique Lomelin
- Melissa Kathleen Lower
- Mary Anastasia McMorrow Adams
- Mount Desert Island Hospital
All providers in Southwest Harbor, ME · Clinical Psychologist in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.