Active NPI
Irene K Koskan, M.D.
- Internal Medicine Physician
- Bay St Louis, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 09338
- Practice address
- 835 Thames Ave
Bay St Louis, MS 39520-5005 - Phone
- (228) 466-4977
- Fax
- (228) 463-0827
- NPI assigned
- Jul 13, 2005
- Reactivated
- Aug 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 09338 | MS | Primary |
Addresses
Primary practice location
835 Thames Ave
Bay St Louis, MS 39520-5005
Mailing address
PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 467-1202
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018846 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1340 Broad Ave
Gulfport, MS 39501-2460
1340 Broad Ave
Gulfport, MS 39501-2465
4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152
835 Thames Ave
Bay St Louis, MS 39520-5005
Phone (228) 466-4977
952 Green Meadow Rd
Bay St Louis, MS 39520-1620
Phone (228) 463-1649
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09338 | MS | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Locations
1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200
4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451
4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872
Interoperability endpoints
- ikoskan@direct.mhg.com
Organizations & group practices 3
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.
-
- Urology Physician
- Gulfport, MS
- NPI 1093142598
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
Hospital & facility affiliations 65
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Gulfport, MS
- NPI 1013142066
-
- Home Health Agency
- Gulfport, MS
- NPI 1174527030
-
- General Acute Care Hospital
- Gulfport, MS
- NPI 1073606901
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1831197862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1810",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395021810",
"telephone_number": "228-467-1202",
"fax_number": "228-467-5361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 THAMES AVE",
"city": "BAY ST LOUIS",
"state": "MS",
"postal_code": "395205005",
"telephone_number": "228-466-4977",
"fax_number": "228-463-0827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSKAN",
"first_name": "IRENE",
"middle_name": "K",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-13",
"last_updated": "2014-07-10",
"deactivation_date": "2006-03-17",
"reactivation_date": "2006-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "09338",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00018846",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bay St Louis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; 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.