Individual provider Active NPI

Ki-Tae Mok, M.D.

  • Hospitalist Physician
  • Albany, NY
National Provider Identifier
1366436230
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
227377 Issued in NY
Practice address
47 New Scotland Ave
Albany, NY 12208-3412
Phone
(518) 262-6279
Fax
(518) 262-5718
NPI assigned
Sep 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 227377 NY
Hospitalist Physician 208M00000X 227377 NY Primary

Addresses

Primary practice location

47 New Scotland Ave
Albany, NY 12208-3412

Mailing address

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-6279

Other practice location 1

600 Northern Blvd
Albany, NY 12204-1004
Phone (518) 471-3221

Other practice location 2

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3300

Other practice location 3

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1550

Other identifiers 1

IdentifierTypeStateIssuer
02563091MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040915000205 NY Practitioner - Internal Medicine 6204803604 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York Downstate Medical Center, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
227377NYMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Jan 1, 2019 Accepting new patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Jan 1, 2019 Accepting new patients
Albany Medical College Internal Medicine Current Accepting new patients
Samaritan Hospital of Troy, New York Internal Medicine CurrentSince Oct 1, 2017 Accepting new patients
Albany Medical College CurrentSince Jan 7, 2017 Accepting new patients
Albany Medical College CurrentSince Jan 7, 2017 Accepting new patients
Albany Medical College Internal Medicine CurrentSince Apr 1, 2019 Accepting new patients
Samaritan Hospital of Troy, New York Internal Medicine CurrentSince Oct 1, 2017 Accepting new patients

Locations

600 Northern Blvd
Albany, NY 12204
Phone (518) 427-3331

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

Interoperability endpoints

  • Direct secure messaging: kmok85132@direct.trinity-health.org

Organizations & group practices 8

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 1

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": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1366436230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 NEW SCOTLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083412",
            "telephone_number": "518-262-6279",
            "fax_number": "518-262-5718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 NEW SCOTLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083412",
            "telephone_number": "518-262-6279",
            "fax_number": "518-262-5718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Northern Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122041004",
            "country_code": "US",
            "telephone_number": "518-471-3221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-271-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 S Manning Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081707",
            "country_code": "US",
            "telephone_number": "518-525-1550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOK",
        "first_name": "KI-TAE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "227377",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "227377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02563091",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.