Takashi Koyama, DMD, PHD FACS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DN16376 Issued in FL

Practice address

2402 Frist Blvd Ste 100
Fort Pierce, FL 34950-4838

Phone

(772) 461-9700

Fax

(772) 461-9300

NPI assigned

Aug 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Perelman School of Med at the University of Pennsylvania, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Lawnwood Hospital Hospital, Fort Pierce, FL, CCN 100246
• Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044
• Cleveland Clinic Indian River Hospital Hospital, Vero Beach, FL, CCN 100105

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Takashi Koyama DMD PHD PA

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fort Pierce, FL
  • NPI 1558429753

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indian River Memorial Hospital Inc

  • General Acute Care Hospital
  • Vero Beach, FL
  • NPI 1376512988
  Care Compare affiliation
• Lawnwood Medical Center Inc

  • General Acute Care Hospital
  • Fort Pierce, FL
  • NPI 1568409647
  Care Compare affiliation
• Martin Memorial Medical Center Inc

  • General Acute Care Hospital
  • Stuart, FL
  • NPI 1194790055
  Care Compare affiliation

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1356459028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 FRIST BLVD STE 100",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504838",
            "telephone_number": "772-461-9700",
            "fax_number": "772-461-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 FRIST BLVD STE 100",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504838",
            "telephone_number": "772-461-9700",
            "fax_number": "772-461-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOYAMA",
        "first_name": "TAKASHI",
        "name_prefix": "Prof.",
        "credential": "DMD, PHD FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN16376",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "DN16376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "DN 16376",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Halina Kolodziej
• Shari Elizabeth Kontrath, BOCPD, CPED
• Anjanaya Prasad Rao Korlipara, M.D.
• Susan Diane Korman, ARNP
• Kathie Kowalczyk, M.D
• Kelli Kraaz, ARNP- FNP
• Kelly Phipps Kramm
• Sharon Jean Krehan, RN
• Dalton Krencik, OTD, OTR/L
• Alan Scott Krimsley, M.D.,

• Oral & Maxillofacial Surgery (D.M.D.) in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.