NPIMap

Individual provider Active NPI

Charles Thomas Koon, M.D.

  • Hospitalist Physician
  • Walla Walla, WA
National Provider Identifier
1467815886
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD61016069 Issued in WA
Practice address
401 W Poplar St
Walla Walla, WA 99362-2846
Phone
(509) 897-3320
NPI assigned
Apr 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD61016069 WA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X MD61016069 WA Primary

Addresses

Primary practice location

401 W Poplar St
Walla Walla, WA 99362-2846

Mailing address

PO Box 32
Liberty Lake, WA 99019-0032
Phone (866) 747-2455

Other practice location 1

121 Dekalb Ave
House Staff Administration
Brooklyn, NY 11201-5425
Phone (718) 250-6604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20210212002032 WA Practitioner - HospitalistPractitioner - Internal Medicine 8325385719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

401 W Poplar St
Walla Walla, WA 99362-2846
Phone (509) 897-3320

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61016069WAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington Internal Medicine CurrentSince Nov 5, 2020 Accepting new patients
Providence Health & Services - Washington Internal Medicine CurrentSince Nov 5, 2020 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

401 W Poplar St
Walla Walla, WA 99362
Phone (509) 522-5731

Organizations & group practices 3

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 8

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": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1467815886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190032",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W POPLAR ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622846",
            "telephone_number": "509-897-3320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Dekalb Ave",
            "address_2": "House Staff Administration",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112015425",
            "country_code": "US",
            "telephone_number": "718-250-6604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOON",
        "first_name": "CHARLES",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-02",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61016069",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD61016069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.