Individual provider Active NPI

George Joseph Koenig Jr., D.O.

  • Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1144490004
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
OS014781 Issued in PA
Practice address
1100 Walnut St
Suite 500
Philadelphia, PA 19107-5563
Phone
(215) 955-6750
NPI assigned
Mar 6, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OT010389 PA
Surgery Physician 208600000X OS014781 PA Primary
Surgery Physician 208600000X H69369 MD
Critical Care Medicine (Anesthesiology) Physician 207LC0200X H69369 MD

Addresses

Primary practice location

1100 Walnut St
Suite 500
Philadelphia, PA 19107-5563

Mailing address

1100 Walnut St
Suite 500
Philadelphia, PA 19107-5563

Other identifiers 3

IdentifierTypeStateIssuer
102494600MedicaidPA
023819800MedicaidMD
0231724MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20101119000499 PA Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 1557416302 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Philadelphia College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Wynewood, PA 19096-3450
Phone (610) 642-1908

925 Chestnut St
FL 6
Philadelphia, PA 19107-4204
Phone (215) 955-6760

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OT010389PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Surgery CurrentSince Aug 1, 2010 Accepting new patients
Main Line Healthcare Surgery CurrentSince Jul 1, 2023 Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients
Jefferson University Physicians Past Accepting new patients
Main Line Hospitals, Inc. Past Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

1100 Walnut St
Ste 500
Philadelphia, PA 19107
Phone (215) 955-6750

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

1100 Walnut St
Fl 5
Philadelphia, PA 19107
Phone (215) 955-6750

1101 Chestnut St
#8
Philadelphia, PA 19107
Phone (215) 955-5869

100 E Lancaster Ave
#275
Wynnewood, PA 19096
Phone (215) 622-3743

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1144490004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WALNUT ST",
            "address_2": "SUITE 500",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WALNUT ST",
            "address_2": "SUITE 500",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075563",
            "telephone_number": "215-955-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "GEORGE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-06",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OT010389",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OS014781",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "H69369",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "MD",
            "license": "H69369",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102494600",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023819800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0231724",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.