Individual provider Active NPI

Christina Koizumi, M.D.

  • Internal Medicine Physician
  • Bronx, NY
National Provider Identifier
1508965336
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
226420 Issued in NY
Practice address
1650 Selwyn Ave
Bronx, NY 10457-7626
Phone
(718) 960-1436
Fax
(718) 960-2054
NPI assigned
Sep 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 226420 NY Primary

Addresses

Primary practice location

1650 Selwyn Ave
Bronx, NY 10457-7626

Mailing address

1650 Selwyn Ave
Bronx, NY 10457-7626
Phone (718) 960-1436

Other identifiers 1

IdentifierTypeStateIssuer
02667623MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050919000933 NY Practitioner - Internal MedicinePractitioner - Infectious Disease 0749214880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Albert Einstein College of Medicine of Yeshiva University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronxcare Health SystemGroup PAC ID 3870404429, 335 clinicians

Practice addresses (Care Compare)

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (718) 992-7669

Hospital & facility affiliations

  • Bronxcare Hospital Center Hospital, Bronx, NY, CCN 330009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
226420NYMDInternal Medicine Physician

Practice roles (4 of 8)

OrganizationSpecialtyStatusNew patients
Bronxcare Health System CurrentSince Feb 11, 2013 Accepting new patients
Bronxcare Health System Internal Medicine Current Accepting new patients
Bronxcare Health System CurrentSince Feb 11, 2013 Accepting new patients
Bronxcare Health System Past Accepting new patients

Locations

1276 Fulton Ave
Rm 208
Bronx, NY 10456
Phone (718) 901-8918

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

1650 Selwyn Ave
Bronx, NY 10457
Phone (718) 466-8153

1650 Selwyn Ave
Fl 9
Bronx, NY 10457
Phone (718) 775-0656

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 4

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 1

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508965336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 SELWYN AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577626",
            "telephone_number": "718-960-1436",
            "fax_number": "718-960-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SELWYN AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577626",
            "telephone_number": "718-960-1436",
            "fax_number": "718-960-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOIZUMI",
        "first_name": "CHRISTINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "226420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02667623",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.