Individual provider Active NPI

Robert Koorn, MD

  • Anesthesiology Physician
  • Redding, CT
National Provider Identifier
1790781615
Registry record updated Mar 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
044260 Issued in CT
Practice address
10 Old Redding Rd
Redding, CT 06896-2201
Phone
(203) 224-3081
NPI assigned
Jun 24, 2005
Last updated
Mar 20, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 200917-1 NY
Anesthesiology Physician 207L00000X 044260 CT Primary
Anesthesiology Physician 207L00000X 5888390-1205 UT

Addresses

Primary practice location

10 Old Redding Rd
Redding, CT 06896-2201

Mailing address

10 Old Redding Rd
Redding, CT 06896-2201
Phone (203) 224-3081

Other identifiers 1

IdentifierTypeStateIssuer
01725644MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20070207000518 CT Practitioner - Anesthesiology 0547228298 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

24 Hospital Ave
Danbury, CT 06810-6099
Phone (203) 739-7118

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200917-1NYMDAnesthesiology Physician
5888390-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nuvance Health Medical Practice CT, Inc. Anesthesiology CurrentSince Apr 30, 2018 Accepting new patients
Pain Management Associates of Norwalk LLC Past Accepting new patients
Connecticut Anesthesia of Fairfield LLC Anesthesiology Past Accepting new patients
Lenox Hill Medical Anesthesiology, PLLC Past Accepting new patients

Locations

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

40 Cross St
Norwalk, CT 06851
Phone (203) 845-2020

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237507200000",
    "number": "1790781615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 OLD REDDING RD",
            "city": "REDDING",
            "state": "CT",
            "postal_code": "068962201",
            "telephone_number": "203-224-3081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 OLD REDDING RD",
            "city": "REDDING",
            "state": "CT",
            "postal_code": "068962201",
            "telephone_number": "203-224-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOORN",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2009-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "200917-1",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "044260",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "5888390-1205",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01725644",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CT

Sources for this page

Verify at the official NPI Registry.