NPIMap

Individual provider Active NPI

Bon Chang A. Koo, MD

  • Gastroenterology Physician
  • New Windsor, NY
National Provider Identifier
1396960043
Registry record updated Apr 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
25MA09230600 Issued in NJ
Practice address
277 Quassaick Avenue (RT. 94)
New Windsor, NY 12553
Phone
(845) 565-5630
Fax
(845) 565-5643
NPI assigned
Apr 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 230774-1 NY
Gastroenterology Physician 207RG0100X 25MA09230600 NJ Primary

Addresses

Primary practice location

277 Quassaick Avenue (RT. 94)
New Windsor, NY 12553

Mailing address

466 Old Hook Rd.
Suite 1
Emerson, NJ 07630-1368
Phone (201) 967-8221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20130712000544 NJ Practitioner - Gastroenterology 9830282730 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
New York University Medical College - NLG, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MPV New Jersey MD Services PCGroup PAC ID 5991097669, 146 clinicians

Practice addresses (Care Compare)

466 Old Hook Rd
Suite 1
Emerson, NJ 07630-1368
Phone (201) 967-8221

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.09 of 100Reported as apm
Quality
86.89
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy59
Upper gastrointestinal (GI) endoscopy for acid reflux90

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
230774-1NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MPV New Jersey MD Services PC CurrentSince Aug 1, 2017 Accepting new patients
Premier Medical Alliance LLC Gastroenterology CurrentSince Jan 21, 2014 Accepting new patients
MPV New Jersey MD Services PC CurrentSince Aug 1, 2017 Accepting new patients
Horizon Medical Group, P.C. PastSince Aug 17, 2025 Accepting new patients
Horizon Medical Group, P.C. Gastroenterology PastSince Nov 3, 1997 Accepting new patients
Hudson Valley Gastroenterology Associates, PC Gastroenterology Past Accepting new patients

Locations

466 Old Hook Rd
Ste 1
Emerson, NJ 07630
Phone (201) 261-0821

1 W Ridgewood Ave
Ste 301
Paramus, NJ 07652
Phone (201) 444-7666

Interoperability endpoints

  • Direct secure messaging: akoo189860@ahs.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/DGICBA

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367193600000",
    "number": "1396960043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD.",
            "address_2": "SUITE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221",
            "fax_number": "201-634-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 QUASSAICK AVENUE (RT. 94)",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "12553",
            "telephone_number": "845-565-5630",
            "fax_number": "845-565-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "BON CHANG",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2013-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "230774-1",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MA09230600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Windsor, NY

Sources for this page

Verify at the official NPI Registry.