Active NPI
Koji Nishimura, M.D.
- Sports Medicine (Family Medicine) Physician
- Fort Benning, GA
National Provider Identifier
1831422682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 0101054889
- Practice address
- Commander, Usameddac and Martin Army Community Hospital
7950 Martin Loop
Fort Benning, GA 31905 - Phone
- (706) 544-4618
- Fax
- (706) 544-3163
- NPI assigned
- Sep 11, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 0101054889 | VA | Primary |
Addresses
Primary practice location
Commander, Usameddac and Martin Army Community Hospital
7950 Martin Loop
Fort Benning, GA 31905
Mailing address
Commander, Usameddac and Martin Army Community Hospital
7950 Martin Loop
Fort Benning, GA 31905
Phone (706) 544-4618
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101054889 | VA | MD | Sports Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252627200000",
"number": "1831422682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "COMMANDER, USAMEDDAC AND MARTIN ARMY COMMUNITY HOSPITAL",
"address_2": "7950 MARTIN LOOP",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "31905",
"telephone_number": "706-544-4618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "COMMANDER, USAMEDDAC AND MARTIN ARMY COMMUNITY HOSPITAL",
"address_2": "7950 MARTIN LOOP",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "31905",
"telephone_number": "706-544-4618",
"fax_number": "706-544-3163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISHIMURA",
"first_name": "KOJI",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-11",
"last_updated": "2009-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "VA",
"license": "0101054889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Benning, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.