Christopher Koulouris, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

032629 Issued in NY

Practice address

2800 Marcus Ave Ste 102
New Hyde Park, NY 11042-1008

Phone

(516) 622-6040

NPI assigned

Sep 26, 2024

Last updated

Mar 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ckoulouris191955@direct.optum.com
• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Optum Medical Care, P.C.

  dba CareMount Medical, P.C.

  • Cardiovascular Disease Physician
  • Mount Kisco, NY
  • NPI 1982643003
  Medicare reassignment Care Compare group
• Ny Society for the Relief of Ruptured & Crippled Maintaining

  dba HSS Ortho 1

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1902243488
  Medicare reassignment
• Optum Medical Care, P.C.

  • Durable Medical Equipment & Medical Supplies
  • New Hyde Park, NY
  • NPI 1053190595
  NPD
• Ny Society for the Relief of Ruptured & Crippled Maintaining

  dba HSS Ortho 1

  • Orthopaedic Surgery Physician
  • Paramus, NJ
  • NPI 1982004529
  NPD
• Mount Kisco Medical Group

  • Hematology (Internal Medicine) Physician
  • Fishkill, NY
  • NPI 1952356362
  NPD (past)
• South Island Orthopedics, P.C.

  • Orthopaedic Surgery Physician
  • Rockville Centre, NY
  • NPI 1912673856
  NPD (past)

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

{
    "created_epoch": "1727308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1356169627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4703 HANFORD ST",
            "city": "DOUGLASTON",
            "state": "NY",
            "postal_code": "113621033",
            "telephone_number": "516-717-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MARCUS AVE STE 102",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421008",
            "telephone_number": "516-622-6040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "575 Underhill Blvd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Syosset",
            "state": "NY",
            "postal_code": "117913431",
            "country_code": "US",
            "telephone_number": "516-622-6040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOULOURIS",
        "first_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-26",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "032629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanjeev V Kothare, MD
• Devki Kothari
• Naomi Pratik Kothary, NP
• Shruti Koti, MD
• Rakesh Kumar Koul, MD
• Koya Rehab, LLC
• David Richard Kraft, MS, RN, NP-C
• Howard J Kraft, MD
• Kari Ann Krajewski, PA-C
• Ann Kramer, C.R.N.A

• Physician Assistant in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.