NPIMap

Individual provider Active NPI

Koshy Oommen, M.D.

  • Internal Medicine Physician
  • Greenwood, IN
National Provider Identifier
1497844278
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01058502A Issued in IN
Practice address
747 E County Line Rd Ste B
Greenwood, IN 46143-1082
Phone
(317) 789-9600
Fax
(317) 789-0600
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01058502A IN Primary

Addresses

Primary practice location

747 E County Line Rd Ste B
Greenwood, IN 46143-1082

Mailing address

747 E County Line Rd Ste B
Greenwood, IN 46143-1082
Phone (317) 789-9600

Other identifiers 3

IdentifierTypeStateIssuer
P01045880OtherINRAILROAD MEDICARE
P00117066OtherINRR MEDICARE
000000333114OtherINCOMMERCIAL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KOOMMEN@AMAZING-DIRECT.COM Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20040622000077 IN Practitioner - Internal Medicine 3375528607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Family Medicine LLCGroup PAC ID 9638308422, 7 clinicians

Practice addresses (Care Compare)

747 E County Line Rd
Suite B
Greenwood, IN 46143-1082
Phone (317) 789-9600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions17
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01058502AINMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Nov 23, 2015 Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine Current Accepting new patients
Sound Physicians of Indiana, LLC Internal Medicine CurrentSince Nov 23, 2015 Accepting new patients
Cathy Yoder MD, LLC Current Accepting new patients
Premier Family Medicine, LLC CurrentSince May 1, 2018 Accepting new patients
Major Hospital Past Accepting new patients

Locations

801 S Main St
Clinton, IN 47842
Phone (765) 832-1212

747 E County Line Rd
Ste B
Greenwood, IN 46143
Phone (317) 472-7812

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Interoperability endpoints

  • Direct secure messaging: koommen@premier-family-medicine.amazing-direct.com
  • Direct secure messaging: koommen@amazing-direct.com

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 9

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1497844278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 E COUNTY LINE RD STE B",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431082",
            "telephone_number": "317-789-9600",
            "fax_number": "317-789-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 E COUNTY LINE RD STE B",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431082",
            "telephone_number": "317-789-9600",
            "fax_number": "317-789-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OOMMEN",
        "first_name": "KOSHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01058502A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01045880",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00117066",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "000000333114",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KOOMMEN@AMAZING-DIRECT.COM",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "747 E County Line Rd Ste B",
            "city": "Greenwood",
            "state": "IN",
            "country_code": "US",
            "postal_code": "461431082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

Verify at the official NPI Registry.