Ezra Koch, MD is a medicare enrolled "General Practice" physician in Mandan, North Dakota. His current practice location is
4108 39th Ave Nw, Mandan, North Dakota. You can reach out to his office (for appointments etc.) via phone at
(701) 426-4291.
Ezra Koch is licensed to practice in North Dakota (license number 19404) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1861016024.
Physician's Profile
Full Name | Ezra Koch |
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Gender | Male |
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Speciality | General Practice |
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Location | 4108 39th Ave Nw, Mandan, North Dakota |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1861016024
- Provider Enumeration Date: 06/03/2020
- Last Update Date: 03/01/2023
Medicare PECOS Information:
- PECOS PAC ID: 0941625214
- Enrollment ID: I20230308002302
Medical Identifiers
Medical identifiers for Ezra Koch such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1861016024 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208D00000X | General Practice | 19404 (North Dakota) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ezra Koch allows following entities to bill medicare on his behalf.
Entity Name | Signify Health Medical Associates Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1750845863 PECOS PAC ID: 2163764424 Enrollment ID: O20200303000565 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ezra Koch is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Ezra Koch, MD 4108 39th Ave Nw, Mandan, ND 58554-1253 Ph: () - | Ezra Koch, MD 4108 39th Ave Nw, Mandan, ND 58554-1253 Ph: (701) 426-4291 |
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