Active NPI
Corey Scott Koenig, DO
- Obstetrics & Gynecology Physician
- Southbridge, MA
National Provider Identifier
1922011642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 72556
- Practice address
- 79 Sayles St
Southbridge, MA 01550-1729 - Phone
- (508) 764-3200
- Fax
- (508) 764-9600
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 72556 | MA | Primary |
Addresses
Primary practice location
79 Sayles St
Southbridge, MA 01550-1729
Mailing address
79 Sayles St
Southbridge, MA 01550-1729
Phone (508) 764-3200
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13730 | Other | MA | HARVARD PILGRIM |
| 3066100 | Medicaid | MA | |
| 072556 | Other | MA | TUFTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72556 | MA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C. Scott Koenig | Obstetrics & Gynecology | Past | Accepting new patients |
| Reliant Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Worcester, MA
- NPI 1720017528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324425600000",
"number": "1922011642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 SAYLES ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015501729",
"telephone_number": "508-764-3200",
"fax_number": "508-764-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 SAYLES ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015501729",
"telephone_number": "508-764-3200",
"fax_number": "508-764-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOENIG",
"first_name": "COREY",
"middle_name": "SCOTT",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2011-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MA",
"license": "72556",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "13730",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3066100",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "072556",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.