NPIMap

Individual provider Active NPI

Timothy Kokanovich, MD

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Fishersville, VA
National Provider Identifier
1477057768
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
64460 Issued in AZ
Practice address
51 Ivy Ridge LN
Fishersville, VA 22939-2339
Phone
(540) 245-7262
Fax
(540) 245-7054
NPI assigned
Mar 21, 2018
Last updated
Nov 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 64460 AZ Primary
Internal Medicine Physician 207R00000X 401 CA

Addresses

Primary practice location

51 Ivy Ridge LN
Fishersville, VA 22939-2339

Mailing address

PO Box 388
Fishersville, VA 22939-0388
Phone (540) 245-7262

Other practice location 1

5777 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 342-2000

Other practice location 2

400 N Pepper Ave
Colton, CA 92324-1801
Phone (909) 580-1000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address timothy.kokanovich.1@14718.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20241217000207 VA Practitioner - Hospice/Palliative Care 6103228440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospice/Palliative Care
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Augusta Medical GroupGroup PAC ID 3678632544, 409 clinicians

Practice addresses (Care Compare)

51 Ivy Ridge LN
Fishersville, VA 22939-2339
Phone (540) 332-5059

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.46 of 100Reported as apm
Quality
90.92
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.47 of 100Reported as group
Quality
78.27
Promoting interoperability
100
Improvement activities
40
Cost
76.62

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
401CAMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
Augusta Medical Group CurrentSince Nov 18, 2024 Accepting new patients
Augusta Medical Group Hospice and Palliative Medicine CurrentSince Nov 18, 2024 Accepting new patients

Locations

51 Ivy Ridge Ln
Fishersville, VA 22939
Phone (540) 245-7262

53 S Medical Park Dr
Fishersville, VA 22939
Phone (540) 332-5687

70 Medical Center Cir
Ste 201
Fishersville, VA 22939
Phone (540) 221-7030

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14718/brand/4/csg/1/fhir/r4
  • Direct secure messaging: timothy.kokanovich.1@14718.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1477057768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229390388",
            "telephone_number": "540-245-7262",
            "fax_number": "540-932-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 IVY RIDGE LN",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392339",
            "telephone_number": "540-245-7262",
            "fax_number": "540-245-7054"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5777 E Mayo Blvd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850544502",
            "country_code": "US",
            "telephone_number": "480-342-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N Pepper Ave",
            "address_purpose": "LOCATION",
            "city": "Colton",
            "state": "CA",
            "postal_code": "923241801",
            "country_code": "US",
            "telephone_number": "909-580-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOKANOVICH",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "AZ",
            "license": "64460",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "401",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timothy.kokanovich.1@14718.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "address_1": "51 Ivy Ridge Ln",
            "city": "Fishersville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229392339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.