Tristan Gregory Kooistra, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

276793 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2621

Phone

(617) 724-9674

NPI assigned

Jun 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Pulmonary DiseaseAlso: Internal Medicine

Education

Harvard Medical School, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Massachusetts General Hospital Hospital, Boston, MA, CCN 220071

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kooistra.tristan.mgh@direct.partners.masshiway.net

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573
  Medicare reassignment Care Compare group NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• General Hospital Corp

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1508390014
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Care Compare affiliation

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1205274305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FRUIT STREET",
            "address_2": "MGH PULMONARY - BUL 148",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02114",
            "telephone_number": "617-724-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-724-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOISTRA",
        "first_name": "TRISTAN",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "256529",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MA",
            "license": "276793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin L. Koo, CNM
• Siulam Ciel Koo, D.O.
• Sophia Koo, M.D.
• Sebastian Hassan John Koochaki, MD, PHD
• Gerald Paul Koocher, PH.D.
• Jacqueline Koomson, MD
• Wilhemina Koomson, MD
• Sarah Callahan Koontz, CNP
• Kameron Kooshesh, MD
• Pavel Kopach, M.D.

• Pulmonary Disease Physician in Boston, MA
• Providers in Boston, MA by specialty
• Pulmonary Disease Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; 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.