Individual provider Active NPI

Gregory Raphael Kotnis, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Denver, CO
National Provider Identifier
1740336429
Registry record updated Sep 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
DR.0050096 Issued in CO
Practice address
6116 E Warren Ave
Denver, CO 80222-5703
Phone
(303) 512-2299
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 0101252050 VA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X DR.0050096 CO Primary

Addresses

Primary practice location

6116 E Warren Ave
Denver, CO 80222-5703

Mailing address

6116 E Warren Ave
Denver, CO 80222-5703
Phone (303) 512-2299

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidVA
99158752MedicaidCO

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
I20240301001896 NY Practitioner - Pathology 2567627649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastern Great Lakes Pathology PCGroup PAC ID 6608861406, 14 clinicians

Practice addresses (Care Compare)

2157 Main St
Buffalo, NY 14214-2648
Phone (716) 862-1769

2605 Harlem Rd
Cheektowaga, NY 14225-4018
Phone (716) 891-2400

2950 Elmwood Ave
Kenmore, NY 14217-1304
Phone (716) 447-8237

565 Abbott Rd
Buffalo, NY 14220-2039
Phone (716) 828-2401

Hospital & facility affiliations

  • Mercy Hospital of Buffalo Hospital, Buffalo, NY, CCN 330279
  • Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078
  • Mount St. Mary'S Hospital & Health Center Hospital, Lewiston, NY, CCN 330188
  • Kenmore Mercy Hospital Hospital, Kenmore, NY, CCN 330102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0050096COMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Great Lakes Pathology PC Anatomic Pathology & Clinical Pathology CurrentSince Mar 1, 2024 Accepting new patients

Locations

20 Northpointe Pkwy
Ste 130
Buffalo, NY 14228

2950 Elmwood Ave
Tonawanda, NY 14217
Phone (716) 447-6100

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.

Hospital & facility affiliations 5

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443052800000",
    "number": "1740336429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6116 E WARREN AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225703",
            "telephone_number": "303-512-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6116 E WARREN AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225703",
            "telephone_number": "303-512-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTNIS",
        "first_name": "GREGORY",
        "middle_name": "RAPHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2015-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "VA",
            "license": "0101252050",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CO",
            "license": "DR.0050096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99158752",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.