NPIMap

Individual provider Active NPI

Keith David Mosienko, M.D.

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Peoria, AZ
National Provider Identifier
1275670242
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X
License
19175 Issued in AZ
Practice address
6865 W Briles Rd
Peoria, AZ 85383-7015
Phone
(623) 376-9038
NPI assigned
Jan 31, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X 19175 AZ Primary

Addresses

Primary practice location

6865 W Briles Rd
Peoria, AZ 85383-7015

Mailing address

6865 W Briles Rd
Peoria, AZ 85383-7015
Phone (623) 376-9038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Clearfield Hospital Past Accepting new patients
Clearfield Hospital Past Accepting new patients
Ingenuity Medical Group LLC Past Accepting new patients
Clearfield Hospital Past Accepting new patients
Willard Emergency Physicians Past Accepting new patients
Team Physicians of Arizona PC Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275670242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6865 W BRILES RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853837015",
            "telephone_number": "623-376-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6865 W BRILES RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853837015",
            "telephone_number": "623-376-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSIENKO",
        "first_name": "KEITH",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "AZ",
            "license": "19175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.