Individual provider Active NPI

Konstantinos Peter Koulogiannis, M.D.

  • Cardiovascular Disease Physician
  • Morristown, NJ
National Provider Identifier
1407042203
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
25MA08970400 Issued in NJ
Practice address
100 Madison Ave
Morristown, NJ 07960-6136
Phone
(973) 971-7416
Fax
(973) 401-2470
NPI assigned
Sep 14, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 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 25MA08970400 NJ Primary
Internal Medicine Physician 207R00000X 246122 NY

Addresses

Primary practice location

100 Madison Ave
Morristown, NJ 07960-6136

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20120502000406 NJ Practitioner - Cardiovascular Disease (Cardiology) 5395834816 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Rutgers New Jersey Medical School, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5596

333 Mount Hope Ave
Rockaway, NJ 07866-1645
Phone (973) 895-6601

95 Madison Ave
Suite 204
Morristown, NJ 07960-6390
Phone (973) 971-7440

Hospital & facility affiliations

  • Morristown Medical Center Hospital, Morristown, NJ, CCN 310015
  • Chilton Medical Center Hospital, Pompton Plains, NJ, CCN 310017

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA08970400NJMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiovascular Health Consultants, P.a. CurrentSince Jan 4, 2014 Accepting new patients
Practice Associates Medical Group Internal Medicine CurrentSince Mar 20, 2012 Accepting new patients

Locations

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

100 Madison Ave
Ste C
Morristown, NJ 07960
Phone (973) 267-9543

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

Organizations & group practices 2

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": "1189728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1407042203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MADISON AVE",
            "city": "MORRISTOWN",
            "state": "NJ",
            "postal_code": "079606136",
            "telephone_number": "973-971-7416",
            "fax_number": "973-401-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOULOGIANNIS",
        "first_name": "KONSTANTINOS",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-14",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA08970400",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "246122",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, NJ

Sources for this page

Verify at the official NPI Registry.