NPIMap

Individual provider Active NPI

Marie Koenig Siddle, PA-C

  • Physician Assistant
  • Pickerington, OH
National Provider Identifier
1891199311
Registry record updated Aug 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
004108 Issued in OH
Practice address
1030 Refugee Rd Ste 280
Pickerington, OH 43147-0019
Phone
(614) 788-4390
Fax
(614) 788-4399
NPI assigned
Oct 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 004108 OH Primary

Addresses

Primary practice location

1030 Refugee Rd Ste 280
Pickerington, OH 43147-0019

Mailing address

PO Box 7527
Dublin, OH 43017-0727

Other names 1

  • Marie Michelle Koenig Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkoenig23854@direct.ohiohealth.com OhioHealth Physician Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20150723007945 OH Practitioner - Physician Assistant 8426361155 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohio Heart Group, Inc.Group PAC ID 2264424134, 8 clinicians

Practice addresses (Care Compare)

800 E Broad St
Columbus, OH 43205-1015
Phone (614) 252-8300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
83.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
004108OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Aug 4, 2024 Accepting new patients
Ohio Heart Group, Inc. Past Accepting new patients
Ohio Heart Group, Inc Past Accepting new patients

Locations

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

1030 Refugee Rd
Ste 280
Pickerington, OH 43147
Phone (614) 788-4390

Organizations & group practices 5

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 6

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": "1413158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722729600000",
    "number": "1891199311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7527",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430170727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 REFUGEE RD STE 280",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431470019",
            "telephone_number": "614-788-4390",
            "fax_number": "614-788-4399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDLE",
        "first_name": "MARIE",
        "middle_name": "KOENIG",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-13",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "004108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkoenig23854@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group, Inc.",
            "address_1": "1030 Refugee Rd Ste 280",
            "city": "Pickerington",
            "state": "OH",
            "country_code": "US",
            "postal_code": "431470019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "KOENIG",
            "middle_name": "MICHELLE",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pickerington, OH

Sources for this page

Verify at the official NPI Registry.