NPIMap

Individual provider Active NPI

Nikoloz Koshkelashvili, M.D.

  • Interventional Cardiology Physician
  • Philadelphia, PA
National Provider Identifier
1295177889
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
63445 Issued in TN
Practice address
5501 Old York Rd
Philadelphia, PA 19141-3018
Phone
(215) 456-6500
NPI assigned
Jul 23, 2013
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 63445 TN
Interventional Cardiology Physician 207RI0011X 63445 TN Primary

Addresses

Primary practice location

5501 Old York Rd
Philadelphia, PA 19141-3018

Mailing address

701 N State of Franklin Rd
Ste 2
Johnson City, TN 37604-3645
Phone (215) 456-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20210727001488 TN Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 4082904065 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Karing Hearts Cardiology PCGroup PAC ID 9436567252, 14 clinicians

Practice addresses (Care Compare)

701 N State of Franklin Rd
Suite 2
Johnson City, TN 37604-3645
Phone (423) 926-4468

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting54
Pacemaker insertion or repair1-10
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
008191GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Karing Hearts Cardiology Heart and Vascular Center Cardiovascular Disease CurrentSince Jan 19, 2025 Accepting new patients
Karing Hearts Cardiology PC Cardiovascular Disease CurrentSince Sep 1, 2021 Accepting new patients
Karing Hearts Cardiology, PLLC Cardiovascular Disease Past Accepting new patients

Locations

627 N Main Ave
Erwin, TN 37650
Phone (423) 735-3405

701 N State of Franklin Rd
Ste 2
Johnson City, TN 37604
Phone (423) 477-0600

701 N State of Franklin Rd
Ste 9
Johnson City, TN 37604
Phone (423) 207-4290

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 7

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": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1295177889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N STATE OF FRANKLIN RD",
            "address_2": "STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043645",
            "telephone_number": "215-456-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "215-456-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSHKELASHVILI",
        "first_name": "NIKOLOZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-23",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "63445",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TN",
            "license": "63445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.