Individual provider Active NPI

Kristopher Koelewyn, DPM

  • Foot & Ankle Surgery Podiatrist
  • San Francisco, CA
National Provider Identifier
1831661578
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5785 Issued in CA
Practice address
505 Parnassus Ave
San Francisco, CA 94143-2204
Phone
(415) 476-1000
NPI assigned
Dec 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X R10615 NY
Foot & Ankle Surgery Podiatrist 213ES0103X E5785 CA Primary

Addresses

Primary practice location

505 Parnassus Ave
San Francisco, CA 94143-2204

Mailing address

112 Hugh St
Vallejo, CA 94591-7504
Phone (559) 707-0452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803003148 CA Practitioner - Podiatry 0648674309 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Robert Marriott Medical CorpGroup PAC ID 2567531494, 63 clinicians

Practice addresses (Care Compare)

1401 New Stine Rd
Bakersfield, CA 93309-3530
Phone (661) 834-0620

2900 Stoneridge Dr
Pleasanton, CA 94588-8310
Phone (925) 201-4050

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue2441
Removal or shaving of skin growth27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5785CAMDProfessional Counselor
E5785CAMDFoot & Ankle Surgery Podiatrist
R10615NYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Current Accepting new patients
University of California SFGH Medical Group CurrentSince Aug 1, 2021 Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 28, 2021 Accepting new patients
Central Valley Foot and Ankle Inc Foot & Ankle Surgery CurrentSince Aug 1, 2022 Accepting new patients
University of California SFGH Medical Group CurrentSince Aug 1, 2021 Accepting new patients
UCSF Dept of Surgery CurrentSince Jul 28, 2021 Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 28, 2021 Accepting new patients
University of California San Francisco CurrentSince Jul 28, 2021 Accepting new patients
Robert Marriott Medical Corp CurrentSince Sep 23, 2024 Accepting new patients
University of California San Francisco CurrentSince Jul 28, 2021 Accepting new patients

Locations

1401 New Stine Rd
Bakersfield, CA 93309
Phone (661) 368-5926

1191 Phelps Ave
Coalinga, CA 93210
Phone (559) 897-5841

222 N Pacific Coast Hwy
Ste 1420
El Segundo, CA 90245

11926 La Mirada Blvd
La Mirada, CA 90638
Phone (562) 943-7156

1428 W North Ave
Lompoc, CA 93436
Phone (805) 735-4010

2278 Nice Ave
Mentone, CA 92359
Phone (909) 204-5000

5225 S J St
Oxnard, CA 93033
Phone (805) 488-3696

751 San Pedro Terrace Rd
Pacifica, CA 94044
Phone (650) 359-4800

150 Bellefontaine St
Pasadena, CA 91105
Phone (626) 793-1103

2225 N Perris Blvd
Perris, CA 92571
Phone (951) 657-2135

2900 Stoneridge Dr
Pleasanton, CA 94588
Phone (925) 201-4000

2120 Stockton Blvd
Sacramento, CA 95817
Phone (916) 452-6631

900 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 419-0956

1001 Potrero Ave
Bldg 53RD
San Francisco, CA 94110
Phone (628) 206-8265

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

400 Parnassus Ave
#A501
San Francisco, CA 94143
Phone (415) 353-2357

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

2580 Samaritan Dr
San Jose, CA 95124
Phone (408) 356-7002

2990 Soquel Ave
Santa Cruz, CA 95062
Phone (831) 479-6950

1321 Franklin St
Santa Monica, CA 90404
Phone (310) 828-5596

501 Petaluma Ave
Sebastopol, CA 95472
Phone (707) 823-8511

116 N Akers St
Visalia, CA 93291
Phone (559) 636-3668

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1831661578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 HUGH ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917504",
            "telephone_number": "559-707-0452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 PARNASSUS AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941432204",
            "telephone_number": "415-476-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELEWYN",
        "first_name": "KRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-19",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "R10615",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.