George John Koullias, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

036119605 Issued in IL

Practice address

100 Hospital Rd
Suite 203
East Patchogue, NY 11772-8809

Phone

(631) 438-5030

Fax

(631) 447-5954

NPI assigned

Nov 26, 2007

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 3

Medicare fee-for-service enrollment

Enrolled in NY

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

Vascular Surgery

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
• St Catherine of Siena Hospital Hospital, Smithtown, NY, CCN 330401
• Chsli St Joseph Hospital Hospital, Bethpage, NY, CCN 330332

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: george.koullias@direct.stonybrookmedicine.edu
• Direct secure messaging: gkoullias90006@direct-chsli.net

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.

• CHS Physician Partners, PC

  • Interventional Cardiology Physician
  • Fresh Meadows, NY
  • NPI 1407089345
  Medicare reassignment Care Compare group NPD
• CHS Physician Partners, P.C

  • Cardiovascular Disease Physician
  • Roslyn, NY
  • NPI 1164585725
  NPD
• CHS Physician Partners, PC

  • Family Medicine Physician
  • Bellmore, NY
  • NPI 1720334527
  NPD
• Illinois Cardiac Surgery Associates SC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Peoria, IL
  • NPI 1114018439
  NPD (past)

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

• Nursing Sisters Home Care, Inc.

  • Home Health Agency
  • Farmingdale, NY
  • NPI 1780670711
  Care Compare affiliation
• St. Catherine of Siena Medical Center

  • General Acute Care Hospital
  • Smithtown, NY
  • NPI 1982663423
  Care Compare affiliation
• Wsnchs North, Inc.

  • General Acute Care Hospital
  • Bethpage, NY
  • NPI 1013998426
  Care Compare affiliation

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384387200000",
    "number": "1992986509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD",
            "address_2": "SUITE 203",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117728809",
            "telephone_number": "631-438-5030",
            "fax_number": "631-447-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL RD",
            "address_2": "SUITE 203",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117728809",
            "telephone_number": "631-438-5030",
            "fax_number": "631-447-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOULLIAS",
        "first_name": "GEORGE",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-26",
        "last_updated": "2013-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036119605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "03619605",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CT LICENSE",
            "identifier": "039729",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD-NY STATE",
            "identifier": "262079",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patric Timothy Knecht, M.D.
• Edward C Kormylo, DPM
• Jeffrey Korn, CCC-SLP
• Christine Maria Koropecky, MD
• Ravindra Kota, M.D.
• Roger D Kramer, PH.D.
• Sue E Kroll, LPN
• William C Krotz, MD
• William P. Kruger, M.D.
• Christina Marie La Barbera, NP

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in East Patchogue, NY
• Providers in East Patchogue, NY by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.