Active NPI
Koh Takeuchi, M.D.
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Greenville, NC
National Provider Identifier
1740603018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- License
- 2014-00071
- Practice address
- 115 Heart Dr
East Carolina Heart Institute at Ecu
Greenville, NC 27834-8944 - Phone
- (252) 744-4400
- Fax
- (252) 744-3987
- NPI assigned
- Jan 22, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 99-7946-99 | MA | |
| Surgery Physician | 208600000X | 2014-00071 | NC | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 2014-00071 | NC | Primary |
Addresses
Primary practice location
115 Heart Dr
East Carolina Heart Institute at Ecu
Greenville, NC 27834-8944
Mailing address
PO Box 751069
Ecu Physicians
Charlotte, NC 28275-1069
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AC1220007-KT869 | Medicaid | MA | |
| 1847S | Other | NC | BCBS NC |
| 1740603018 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99-7946-99 | MA | MD | Specialist |
| 2014-00071 | NC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399507200000",
"number": "1740603018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751069",
"address_2": "ECU PHYSICIANS",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 HEART DR",
"address_2": "EAST CAROLINA HEART INSTITUTE AT ECU",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278348944",
"telephone_number": "252-744-4400",
"fax_number": "252-744-3987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKEUCHI",
"first_name": "KOH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-22",
"last_updated": "2014-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MA",
"license": "99-7946-99",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "2014-00071",
"primary": false
},
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "NC",
"license": "2014-00071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "AC1220007-KT869",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "1847S",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1740603018",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.