Mark Alan Koenig, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

174687 Issued in NY

Practice address

765 Route 25a Ste 6
Miller Place, NY 11764-2649

Phone

(631) 320-3200

Fax

(631) 350-7798

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Family PracticeAlso: Osteopathic Manipulative Medicine

Education

New York College of Osteo Medicine of New York Institute of Technology, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caremed Primary and Urgent Care PCGroup PAC ID 8224353727, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
• Constellation Home Care Home health agency, Syosset, NY, CCN 337447
• Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
• St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Caremed Primary and Urgent Care PC

  • Internal Medicine Physician
  • Patchogue, NY
  • NPI 1487050134

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Mark a. Koenig, D.O., P.C.

  • Primary Care Clinic/Center
  • Middle Island, NY
  • NPI 1265708374
  NPD (past) Authorized official
• Main Street Medical, PC

  • Internal Medicine Physician
  • Bay Shore, NY
  • NPI 1184049835
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Constellation Home Care LLC

  • Home Health Agency
  • Syosset, NY
  • NPI 1841629698
  Care Compare affiliation
• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• Nursing Sisters Home Care, Inc.

  • Home Health Agency
  • Farmingdale, NY
  • NPI 1780670711
  Care Compare affiliation
• St Charles Hospital Corp

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1164481529
  Care Compare affiliation
• Tender Loving Care Health Care Services of Nassau Suffolk, LLC

  • Home Health Agency
  • Medford, NY
  • NPI 1699715961
  Care Compare affiliation

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1831252964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 E ROE BLVD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722631",
            "telephone_number": "631-475-3900",
            "fax_number": "631-866-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 ROUTE 25A STE 6",
            "city": "MILLER PLACE",
            "state": "NY",
            "postal_code": "117642649",
            "telephone_number": "631-320-3200",
            "fax_number": "631-350-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "174687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01263721",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Keenan, PSY.D.
• Michele Kennelly, LMT
• Natasha Khrimian, LPN
• Noreen Killeen, R.N.
• Eunhee Kim
• Harvey Alan Kolker, MD
• Cori Kresge
• Hannah Marie Kuemmel, ATC
• Donna Lanza, PT
• Margaret Marie Laskowski, CCC-SLP

• Family Medicine Physician in Miller Place, NY
• Providers in Miller Place, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.

Verify at the official NPI Registry.