NPIMap

Individual provider Active NPI

Michael R Koenig, MD

  • Family Medicine Physician
  • Garden Valley, ID
National Provider Identifier
1851396386
Registry record updated Apr 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M8699 Issued in ID
Practice address
856 Banks Lowman Rd
Garden Valley, ID 83622-8102
Phone
(208) 462-3533
Fax
(208) 462-3736
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M8699 ID Primary

Addresses

Primary practice location

856 Banks Lowman Rd
Garden Valley, ID 83622-8102

Mailing address

PO Box 270
Garden Valley, ID 83622-0270
Phone (208) 462-3533

Other identifiers 3

IdentifierTypeStateIssuer
000010140515OtherIDBS
85795OtherIDBC
806406200MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051017000992 ID Practitioner - Family Practice 6002832276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Garden Valley Family Medicine PCGroup PAC ID 0648296814, 6 clinicians

Practice addresses (Care Compare)

856 Banks Lowman Rd
Garden Valley, ID 83622-8102
Phone (208) 462-5533

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8699IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Garden Valley Family Medicine PC Family Medicine CurrentSince Sep 1, 2005 Accepting new patients
Achieve Physical Therapy PLLC PastSince Sep 1, 2005 Accepting new patients
DM Management PC Past Accepting new patients

Locations

856 Banks Lowman Rd
Garden Valley, ID 83622
Phone (208) 462-3533

102 Quinn St
Horseshoe Bend, ID 83629
Phone (208) 793-2257

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.

Hospital & facility affiliations 12

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301961600000",
    "number": "1851396386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "GARDEN VALLEY",
            "state": "ID",
            "postal_code": "836220270",
            "telephone_number": "208-462-3533",
            "fax_number": "208-462-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "856 BANKS LOWMAN RD",
            "city": "GARDEN VALLEY",
            "state": "ID",
            "postal_code": "836228102",
            "telephone_number": "208-462-3533",
            "fax_number": "208-462-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2011-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M8699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "000010140515",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "85795",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806406200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Valley, ID

Sources for this page

Verify at the official NPI Registry.