Individual provider Active NPI

Jason Joseph Koenig, NP-C

  • Family Nurse Practitioner
  • Poland, OH
National Provider Identifier
1225780026
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0030593 Issued in OH
Practice address
715 E Western Reserve Rd
Poland, OH 44514-3358
Phone
(330) 726-3204
NPI assigned
Jan 22, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0030593 OH Primary

Addresses

Primary practice location

715 E Western Reserve Rd
Poland, OH 44514-3358

Mailing address

501 Woodbury CT
Canfield, OH 44406-9632
Phone (330) 842-1584

Other practice location 1

501 Woodbury Ct
Canfield, OH 44406-9632
Phone (330) 842-1584

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20220627003073 OH Practitioner - Nurse Practitioner 5193104883 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

715 E Western Reserve Rd
Poland, OH 44514-3358
Phone (330) 726-3204

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0030593OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Mar 16, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC Nurse Practitioner Current Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Mar 16, 2022 Accepting new patients

Locations

1701 Mercy Health Pl
Cincinnati, OH 45237
Phone (513) 952-5000

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

715 E Western Reserve Rd
Youngstown, OH 44514
Phone (330) 726-3204

Interoperability endpoints

  • Direct secure messaging: jkoenig178377@direct.bsmhealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1642809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1225780026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WOODBURY CT",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069632",
            "telephone_number": "330-842-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E WESTERN RESERVE RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445143358",
            "telephone_number": "330-726-3204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Woodbury Ct",
            "address_purpose": "LOCATION",
            "city": "Canfield",
            "state": "OH",
            "postal_code": "444069632",
            "country_code": "US",
            "telephone_number": "330-842-1584",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "JASON",
        "middle_name": "JOSEPH",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-22",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "0030593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

Verify at the official NPI Registry.