Individual provider Active NPI

Aung Ko Ko Thant, M.D.

  • Family Medicine Physician
  • Buffalo, NY
National Provider Identifier
1730522541
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
290722 Issued in NY
Practice address
1021 Broadway St
Buffalo, NY 14212-1460
Phone
(716) 529-3020
Fax
(716) 529-3040
NPI assigned
Apr 10, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 290722 NY Primary

Addresses

Primary practice location

1021 Broadway St
Buffalo, NY 14212-1460

Mailing address

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 881-6191

Other practice location 1

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 881-6191

Other practice location 2

550 1st Ave
New York, NY 10016
Phone (212) 263-5506

Other identifiers 1

IdentifierTypeStateIssuer
05228217MedicaidNY

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
I20180911002644 NY Practitioner - Family Practice 7315297496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jericho Road Ministries, Inc.Group PAC ID 5597992933, 33 clinicians

Practice addresses (Care Compare)

1021 Broadway St
Buffalo, NY 14212-1460
Phone (716) 529-3020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
290722NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Jericho Road Ministries Inc. CurrentSince Sep 3, 2018 Accepting new patients

Locations

1021 Broadway St
Buffalo, NY 14212
Phone (716) 529-3020

21 Doat St
Buffalo, NY 14211
Phone (716) 339-9210

182 Breckenridge St
Buffalo, NY 14213
Phone (716) 348-3011

184 Barton St
Buffalo, NY 14213
Phone (716) 348-3000

100 E Tupper St
Buffalo, NY 14203
Phone (716) 539-6743

Interoperability endpoints

  • Direct secure messaging: aung.thant@jrchc.medentdirect.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1730522541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BROADWAY ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142121460",
            "telephone_number": "716-529-3020",
            "fax_number": "716-529-3040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "184 Barton St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142131573",
            "country_code": "US",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6191",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10016",
            "country_code": "US",
            "telephone_number": "212-263-5506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THANT",
        "first_name": "AUNG",
        "middle_name": "KO KO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "290722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05228217",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.