Leon Koenck, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA19714 Issued in CA

Practice address

46900 Ocean Dr
Ste 1100
Gualala, CA 95445-8353

Phone

(707) 884-4005

Fax

(707) 884-4625

NPI assigned

Mar 13, 2007

Last updated

Feb 2, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20726/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: leon.koenck.p1@direct.rcms-healthcare.nextgenshare.com

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.

• Redwood Coast Medical Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gualala, CA
  • NPI 1962530725
  Medicare reassignment
• Redwood Coast Medical Services, Inc.

  • Community Health Clinic/Center
  • Point Arena, CA
  • NPI 1275778847
  NPD
• Alaska Imaging Associates, LLC

  dba Northern Lights Imaging

  • Diagnostic Radiology Physician
  • Anchorage, AK
  • NPI 1063466688
  NPD (past)
• Bristol Bay Borough

  dba Camai Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Naknek, AK
  • NPI 1629105804
  NPD (past)
• Camai Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Naknek, AK
  • NPI 1679718019
  NPD (past)
• Winnebago Indian Health Service

  • General Acute Care Hospital
  • Winnebago, NE
  • NPI 1659392454
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1164555769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WEST 34TH AVENUE",
            "address_2": "#539",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99503",
            "telephone_number": "888-300-0137",
            "fax_number": "888-300-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46900 OCEAN DR",
            "address_2": "STE 1100",
            "city": "GUALALA",
            "state": "CA",
            "postal_code": "954458353",
            "telephone_number": "707-884-4005",
            "fax_number": "707-884-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENCK",
        "first_name": "LEON",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "270",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19714",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA 10003212",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA19714",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003212",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Hand, N.P.
• Douglas Scott Herting, DOCTOR OF CHIRO
• Stephanie Hsieh
• Mark Kal, M.D.
• Renee Kaucnik, THERAPIST
• Lisa Heying Kritz
• Shaye Larie, NP
• Lisa Kritz Physical Therapy Inc.
• Lucinda Weaver Physical Therapy
• Jessica B Maness, LICSW

• Physician Assistant in Gualala, CA
• Providers in Gualala, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.