Jonathan S Koelle, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G79002 Issued in CA

Practice address

4700 Spring St
Suite 220
La Mesa, CA 91951-5274

Phone

(619) 667-3380

Fax

(619) 667-0815

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Psychiatry

Education

Pennsylvania State University College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mark David Levine MD Professional CorporationGroup PAC ID 0143478305, 165 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkoelle80451@scrippshlth.medalliesdirect.net
• Direct secure messaging: jonathan.koelle.p1@direct.pcsd.nextgenshare.com

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.

• Mark David Levine M.D. Professional Corporation

  dba Mindpath Health

  • Psychiatry Physician
  • Sacramento, CA
  • NPI 1154697944
  Medicare reassignment Care Compare group NPD
• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942
  Medicare reassignment NPD
• Psychiatric Centers at San Diego, Inc. Med GRP

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1841241585
  Medicare reassignment
• Mark David Levine, MD Burlingame PC

  dba Community Psychiatry Associates

  • Psychiatry Physician
  • San Mateo, CA
  • NPI 1770709263
  NPD
• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1609803824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609001",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921609001",
            "telephone_number": "619-528-4600",
            "fax_number": "619-528-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 SPRING ST",
            "address_2": "SUITE 220",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919515274",
            "telephone_number": "619-667-3380",
            "fax_number": "619-667-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELLE",
        "first_name": "JONATHAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G79002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Klimochkin, RRT
• Laurel Klotz
• KMJ Medical Group Incorporated
• Regina Mona Knox, RADT, AMFT
• Joy N Kobrick
• Koerner Psychology, PC
• David Alin Kohanyi, LMFT
• Lana Konovalova
• Jennifer Moreen Kostrinsky, D.O
• Kotha Flamenco Dental Corporation (Helix Dental)

• Psychiatry Physician in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.