Phillip A Kohanov, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003217 Issued in MI

Practice address

3833 24TH Ave
Fort Gratiot, MI 48059-4100

Phone

(810) 985-5600

Fax

(910) 985-5740

NPI assigned

Nov 2, 2005

Last updated

Jun 6, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Phillip a. Kohanov O.D. PC

  • Optometrist
  • Fort Gratiot, MI
  • NPI 1821279159
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338940800000",
    "number": "1184615742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594100",
            "telephone_number": "810-985-5600",
            "fax_number": "910-985-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594100",
            "telephone_number": "810-985-5600",
            "fax_number": "910-985-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHANOV",
        "first_name": "PHILLIP",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGION B DMERC",
            "identifier": "1038350001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900G465140",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mikala Kish
• Kari J Kliemann
• Lou Ann Klinger
• Aspria Knight
• Paige Eileen Koglin
• Richard R Kovar, DO
• Michael Brian Kreiner
• Randy Krieg, RPH
• Kristen Nicole Kronner
• Melissa Dawn Kruse, LMSW/ACSW

• Optometrist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.