NPIMap

Individual provider Active NPI

Justin Kosirog

  • Gastroenterology Physician
  • Oklahoma City, OK
National Provider Identifier
1255726238
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35686 Issued in OK
Practice address
800 Stanton L Young Blvd # Wp1345
Oklahoma City, OK 73104-5018
Phone
(405) 271-5428
NPI assigned
Apr 6, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X 35686 OK Primary

Addresses

Primary practice location

800 Stanton L Young Blvd # Wp1345
Oklahoma City, OK 73104-5018

Mailing address

800 Stanton L Young Blvd # Wp1345
Oklahoma City, OK 73104-5018
Phone (405) 271-5428

Other practice location 1

1740 W Taylor St
Chicago, IL 60612-7232
Phone (866) 600-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230525001819 IL Practitioner - Internal MedicinePractitioner - Gastroenterology 9739499922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Gastroenterology Group LLCGroup PAC ID 5193857423, 116 clinicians

Practice addresses (Care Compare)

745 Fletcher Dr
Suite 202
Elgin, IL 60123-4749
Phone (847) 888-1300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.21 of 100Reported as group
Quality
67.65
Promoting interoperability
99
Improvement activities
40
Cost
80.55

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy76
Upper gastrointestinal (GI) endoscopy for acid reflux91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35686OKMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elgin Gastroenterology Endoscopy Center LLC Current Accepting new patients
Northwest Gastroenterologists SC Current Accepting new patients
Elgin Gastroenterology SC Gastroenterology Current Accepting new patients
Illinois Gastroenterology Group, LLC Gastroenterology CurrentSince Jun 15, 2023 Accepting new patients

Locations

745 Fletcher Dr
Ste 202
Elgin, IL 60123
Phone (855) 483-7362

1555 N Barrington Rd
Ste 400
Hoffman Estates, IL 60169
Phone (847) 519-1600

165 N Lakewood Rd
Ste D
Lake in the Hills, IL 60156

2550 W Algonquin Rd
Lk in the Hls, IL 60156
Phone (847) 458-1246

2000 McDonald Rd
Ste 260
South Elgin, IL 60177

Organizations & group practices 4

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 5

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": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1255726238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # WP1345",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD # WP1345",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "405-271-5428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1740 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127232",
            "country_code": "US",
            "telephone_number": "866-600-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSIROG",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OK",
            "license": "35686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.