Individual provider Active NPI

Koichi Nomoto, M.D.

  • Critical Care Medicine (Anesthesiology) Physician
  • Oklahoma City, OK
National Provider Identifier
1881854404
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
License
43864 Issued in OK
Practice address
920 Stanton L Young Blvd Ste 1140
Oklahoma City, OK 73104-5036
Phone
(405) 271-4351
NPI assigned
Jun 17, 2008
Last updated
Feb 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 003454 NY
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 003454 NY
Cardiovascular Disease Physician 207RC0000X 003454 NY
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 43864 OK Primary

Addresses

Primary practice location

920 Stanton L Young Blvd Ste 1140
Oklahoma City, OK 73104-5036

Mailing address

PO Box 26901
Oklahoma City, OK 73126-0901

Other practice location 1

1 Gustave L Levy Pl
Anesthesiology - Box 1010
New York, NY 10029-6500
Phone (800) 627-4470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OK2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091124000473 NY Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 1254470651 Reassigns benefits to 2 organizations
I20250130003076 OK Practitioner - Anesthesiology 1254470651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ou Health Partners IncGroup PAC ID 5991105876, 1,167 clinicians

Practice addresses (Care Compare)

900 NE 10TH St
Ouhp Family Medicine
Oklahoma City, OK 73104-5420
Phone (572) 244-0065

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Anesthesiology CurrentSince Jul 1, 2016 Accepting new patients
Ou Health Partners, Inc CurrentSince Jan 3, 2025 Accepting new patients
Ou Health Partners, Inc CurrentSince Jan 3, 2025 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 24, 2020 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients

Locations

13620 38th Ave
Flushing, NY 11354
Phone (718) 353-7701

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

1190 5th Ave
#2W
New York, NY 10029
Phone (212) 241-5646

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

920 Stanton L Young Blvd
Ste 1140
Oklahoma City, OK 73104

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1881854404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26901",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731260901",
            "fax_number": "412-937-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 STANTON L YOUNG BLVD STE 1140",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045036",
            "telephone_number": "405-271-4351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_2": "Anesthesiology - Box 1010",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296500",
            "country_code": "US",
            "telephone_number": "800-627-4470",
            "fax_number": "412-937-5710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOMOTO",
        "first_name": "KOICHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "003454",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "NY",
            "license": "003454",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "003454",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "OK",
            "license": "43864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.