Kelly Lee Koenig, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

Q0294 Issued in TX

Practice address

120 E Harris Ave
San Angelo, TX 76903-5904

Phone

(325) 658-1511

Fax

(325) 481-2166

NPI assigned

May 6, 2010

Sex

Male

Sole proprietor

No

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 TX

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

Emergency Medicine

Education

Arizona College of Osteopathic Medicine Mid Western University, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Shannon Medical Center Hospital, San Angelo, TX, CCN 450571

Merit-based Incentive Payment System (MIPS)

Final score

82.63 of 100Reported as group

Quality

78.21

Promoting interoperability

96

Improvement activities

40

Cost

67.22

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkoenig6766@shannonhealth.direct-ci.com

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.

• Shannon Clinic

  • Family Medicine Physician
  • San Angelo, TX
  • NPI 1770587149
  Medicare reassignment Care Compare group NPD
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Jackson County Memorial Hospital Authority

  dba Harmon Memorial Hospital

  • Critical Access Hospital
  • Hollis, OK
  • NPI 1295735991
  NPD (past)
• Oklahoma Emergency Services PC

  • Emergency Medicine Physician
  • Lawton, OK
  • NPI 1114239795
  NPD (past)

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

• Shannon Medical Center

  • General Acute Care Hospital
  • San Angelo, TX
  • NPI 1992707228
  Care Compare affiliation

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

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1861710576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E HARRIS AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035904",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-06",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q0294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EN017",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Knecht
• Tessa Knickerbocker, LPC
• James Lee Knight, LCDC
• Ronald Lynn Knight, DDS MSD
• Kathleen Anne Koehn, OTR
• Jai Krishna Srikanth Kolliboyana, DDS
• Sanaya Girish Kondaskar, MOT
• Seth Ramsey Koschak, DDS
• Anna Kosztowski, MD
• Ashok Kumar Koul, MD

• Emergency Medicine Physician in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; 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.