Individual provider Active NPI

Michelle Elaine Koski, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • San Diego, CA
National Provider Identifier
1144377938
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X
License
A125665 Issued in CA
Practice address
5893 Copley Dr
Kaiser Garfield Department of Urology
San Diego, CA 92111-7906
Phone
(888) 694-7857
Fax
(760) 510-5782
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD.203505 LA
Urology Physician 208800000X 34108 SC
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X A125665 CA Primary

Addresses

Primary practice location

5893 Copley Dr
Kaiser Garfield Department of Urology
San Diego, CA 92111-7906

Mailing address

5893 Copley Dr
Kaiser Garfield Department of Urology
San Diego, CA 92111-7906
Phone (888) 694-7857

Other identifiers 1

IdentifierTypeStateIssuer
203505MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20131231000170 CA Practitioner - Urology 0143480038 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.203505LAMDUrology Physician
A125665CAMDFemale Pelvic Medicine and Reconstructive Surgery (Urology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 2, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 2, 2013 Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

5893 Copley Dr
San Diego, CA 92111
Phone (858) 616-5100

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1144377938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5893 COPLEY DR",
            "address_2": "KAISER GARFIELD DEPARTMENT OF UROLOGY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117906",
            "telephone_number": "888-694-7857",
            "fax_number": "760-510-5782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5893 COPLEY DR",
            "address_2": "KAISER GARFIELD DEPARTMENT OF UROLOGY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117906",
            "telephone_number": "888-694-7857",
            "fax_number": "760-510-5782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSKI",
        "first_name": "MICHELLE",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "MD.203505",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "34108",
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "CA",
            "license": "A125665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203505",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.