Thomas A Kenigsberg, M.D.
Individual provider Active NPI Family Medicine Physician · Johnstown, CO
NPI 1467412650 · NPPES record last updated Feb 13, 2009
Key facts
- NPI
- 1467412650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 37268 (CO)
- Practice address
- 222 Johnstown Center Dr
Johnstown, CO 80534-9030 - Phone
- (970) 587-4974
- Fax
- (970) 587-5466
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Colorado School of Medicine, Denver, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Banner Health Physicians Colorado LLC
Practice addresses (Care Compare)
1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121
222 Johnstown Ctr Dr
Johnstown, CO 80534-9030
Phone (970) 587-4974
Hospital & facility affiliations
- Banner North Colorado Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050312000031 | CO | Practitioner - Family Practice | 5395790398 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37268 | CO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banner Health Physicians Colorado LLC | Current |
Accepting new patients | |
| Banner Health Physicians Colorado LLC | Current |
Accepting new patients | |
| North Colorado Medical Center | Past | Accepting new patients | |
| Banner Health Physicians Colorado LLC | Past | Accepting new patients | |
| Banner Medical Group Greeley LLC | Past | Accepting new patients |
Locations
1801 16th St
Greeley, CO 80631
Phone (970) 352-4121
1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121
222 Johnstown Center Dr
Johnstown, CO 80534
Phone (970) 587-4974
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 37268 | CO | Yes |
Addresses
Primary practice location
222 Johnstown Center Dr
Johnstown, CO 80534-9030
Mailing address
1010 N Country Club Dr
Mesa, AZ 85201-3309
Phone (480) 461-2409
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01372689 | Medicaid | CO |
Other providers in Johnstown, CO
- Johnstown Family Physicians
- Johnstown Heights Behavioral Health, LLC
- Johnstown Pediatric Dentistry PLLC
- Kaiser Foundation Health Plan of Co
- Kaiser Foundation Health Plan of Colorado
- Brandy Knudtson
- Christopher J Kottenstette
- Joseph Thomas Kraus
- Eric Jonathan Krinsky
- Matthew Krizek
All providers in Johnstown, CO · Family Medicine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.