NPIMap

Individual provider Active NPI

Majed A Koleilat, MD

  • Allergy & Immunology Physician
  • Evansville, IN
National Provider Identifier
1922175694
Registry record updated Jan 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
01061301A Issued in IN
Practice address
421 Chestnut St
Evansville, IN 47713-1227
Phone
(812) 426-9459
Fax
(812) 858-4546
NPI assigned
Nov 29, 2006
Last updated
Jan 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 01061301A IN Primary

Addresses

Primary practice location

421 Chestnut St
Evansville, IN 47713-1227

Mailing address

PO Box 3868
Evansville, IN 47737-3868
Phone (812) 426-9459

Other identifiers 2

IdentifierTypeStateIssuer
000000381373OtherINANTHEM
200538870MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20051104000448 IN Practitioner - Allergy/Immunology 2365460656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

1204 Williams St
Oakland City, IN 47660-1001
Phone (812) 749-6187

251 S Truman Rd
Deaconess Clinic Jasper Allergy
Jasper, IN 47546-9768
Phone (812) 479-3153

4011 Gateway Blvd
Newburgh, IN 47630-8947
Phone (812) 490-4570

421 Chestnut St
Evansville, IN 47713-1227
Phone (812) 426-6645

6221 Physicians CT
Suite 1
Evansville, IN 47715-4031
Phone (812) 479-3153

685 Vail St
Princeton, IN 47670-9510
Phone (812) 386-6560

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01061301AINMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic Inc CurrentSince Oct 1, 2008 Accepting new patients
Deaconess Clinic Inc. Allergy & Immunology Current Accepting new patients
Deaconess Clinic, Inc CurrentSince Oct 1, 2008 Accepting new patients
Geisinger Clinic Past Accepting new patients
Deaconess Clinic, Inc Past Accepting new patients

Locations

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

6221 Physicians Ct
Ste 1
Evansville, IN 47715
Phone (812) 479-3153

4233 Gateway Blvd
Newburgh, IN 47630
Phone (812) 474-7116

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

Interoperability endpoints

  • Direct secure messaging: mkoleilat2430@direct.deaconess.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Deaconess Clinic MorganfieldMorganfield, KY, CCN 183968 Rural health clinic Corporate Director Oct 1, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357171200000",
    "number": "1922175694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3868",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477373868",
            "telephone_number": "812-426-9459",
            "fax_number": "812-858-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CHESTNUT ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477131227",
            "telephone_number": "812-426-9459",
            "fax_number": "812-858-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLEILAT",
        "first_name": "MAJED",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "IN",
            "license": "01061301A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000381373",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200538870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.