NPIMap

Individual provider Active NPI

John Kenneth Kosik, D.O.

  • Family Medicine Physician
  • Teec Nos Pos, AZ
National Provider Identifier
1568532562
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5766873-1204 Issued in UT
Practice address
HCR 61 Box 30
JCT US Hwy 160 & NR 35 - Red Mesa
Teec Nos Pos, AZ 86514
Phone
(928) 656-5000
Fax
(928) 656-5164
NPI assigned
Nov 8, 2006
Last updated
Apr 19, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5766873-1204 UT Primary

Addresses

Primary practice location

HCR 61 Box 30
JCT US Hwy 160 & NR 35 - Red Mesa
Teec Nos Pos, AZ 86514

Mailing address

HCR 61 Box 30
JCT US Hwy 160 & NR 35 - Red Mesa
Teec Nos Pos, AZ 86514
Phone (928) 656-5000

Other identifiers 3

IdentifierTypeStateIssuer
260813MedicaidAZ
36250767MedicaidNM
40584054MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20070907000714 TX Practitioner - Family Practice 7113010067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS PHS Naihs Shiprock HospitalGroup PAC ID 0749193837, 148 clinicians

Practice addresses (Care Compare)

6 Rd
Suite 7586
Bloomfield, NM 87413-4934
Phone (505) 368-6401

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5766873-1204UTMDFamily Medicine Physician
5026AZMDSkilled Nursing Facility

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Feb 5, 2013 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients

Locations

6 Road 7586
Bloomfield, NM 87413
Phone (505) 368-8015

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 7

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": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1568532562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HCR 61 BOX 30",
            "address_2": "JCT US HWY 160 & NR 35 - RED MESA",
            "city": "TEEC NOS POS",
            "state": "AZ",
            "postal_code": "86514",
            "telephone_number": "928-656-5000",
            "fax_number": "928-656-5164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HCR 61 BOX 30",
            "address_2": "JCT US HWY 160 & NR 35 - RED MESA",
            "city": "TEEC NOS POS",
            "state": "AZ",
            "postal_code": "86514",
            "telephone_number": "928-656-5000",
            "fax_number": "928-656-5164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSIK",
        "first_name": "JOHN",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5766873-1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260813",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36250767",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40584054",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Teec Nos Pos, AZ

Sources for this page

Verify at the official NPI Registry.