Thomas N Koutelos, INTERNAL MEDICINE

Primary specialty

SpecialistTaxonomy code 174400000X

License

19052 1 Issued in NY

Practice address

25 Plaza St W Ste 1F
421 78TH Street Brooklyn Ny 11209
Brooklyn, NY 11217-3942

Phone

(718) 622-1025

Fax

(718) 622-0915

NPI assigned

Nov 20, 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

Other identifiers 17

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

Specialty

Internal Medicine

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northern Medical Group, PLLCGroup PAC ID 6901104157, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Putnam Hospital Center Hospital, Carmel, NY, CCN 330273

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CJAHCA
• Direct secure messaging: thomas.koutelos@nmgmd.eclinicaldirectplus.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.

• Northern Medical Group, PLLC

  • Internal Medicine Physician
  • Brewster, NY
  • NPI 1174994826
  Medicare reassignment Care Compare group NPD
• Long Island College Hospital

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1912091828
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Putnam Hospital Center

  • General Acute Care Hospital
  • Carmel, NY
  • NPI 1972557379
  Care Compare affiliation

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679647465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 PLAZA ST W STE 1F",
            "address_2": "421 78TH STREET BROOKLYN NY 11209",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173942",
            "telephone_number": "718-622-1025",
            "fax_number": "718-622-0915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 PLAZA ST W STE 1F",
            "address_2": "421 78TH STREET BROOKLYN NY 11209",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173942",
            "telephone_number": "718-622-1025",
            "fax_number": "718-622-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUTELOS",
        "first_name": "THOMAS",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "INTERNAL MEDICINE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "19052 1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01366774",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGNACARE",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS HEALTHNET OF NE",
            "identifier": "IC7375",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P809058",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC-BS",
            "identifier": "10L46",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1199",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP OF NY",
            "identifier": "190521",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO PPO",
            "identifier": "2023469",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED EMPIRE",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5699985",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PPO HMO",
            "identifier": "6638812006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLEAR#",
            "identifier": "33D0709729",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "11 0240756",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI PLAN",
            "identifier": "113416490",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER UNION",
            "identifier": "113416490",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Kourmolis, P.T.
• Sharon Kourt, CSW
• Soultana Kourtidou, MD, MSC
• Michele Koury, LMHC
• Konstantinos Koutelos, M.D.
• Andreas Koutras, MD
• Konstantinos Koutros, MD
• Stella Koutsakis-Rallakis, RN
• Kathy Tina Koutsianas
• Haroula Harriet Koutsivitis, MA, CCC-SLP

• Specialist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.