KOINONIA PRIMARY CARE INC
NPI 1023389533
Clinic/Center in Albany, NY
About Koinonia Primary Care Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KOINONIA PRIMARY CARE INC (NPI 1023389533), doing business as Koinonia Primary Medical Care Pc, is a healthcare organization registered as a clinic/center in Albany, New York and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Robert John Paeglow, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Koinonia Primary Care Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Koinonia Primary Care Inc, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 33D0998757
Koinonia Primary Care Inc · Albany, NYFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Koinonia Primary Care Inc's NPI number?
The NPI number for Koinonia Primary Care Inc is 1023389533. It was assigned to this organization in the NPPES registry on January 16, 2012. The provider was formerly known as Koinonia Primary Medical Care PC.
Where is Koinonia Primary Care Inc located?
Koinonia Primary Care Inc is located at 553 Clinton Ave, Albany, NY 12206. The listed phone number is (518) 689-0282.
What is Koinonia Primary Care Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Koinonia Primary Care Inc enrolled in Medicare?
Yes. Koinonia Primary Care Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Koinonia Primary Care Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 3 Medicare specialties reassign their Medicare billing to Koinonia Primary Care Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4), Clinical Social Worker (2) and Family Practice (1). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Koinonia Primary Care Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 33D0998757) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Koinonia Primary Care Inc was last updated on January 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Koinonia Primary Care Inc · NPI 1023389533
Clinic/Center organization in Albany, New York. Organization record, active in the CMS NPPES registry since January 16, 2012.
## Identity
- **NPI:** 1023389533 (Entity type: Organization)
- **Enumerated:** January 16, 2012
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Robert Paeglow, PRESIDENT
## Practice location
- **Address:** 553 CLINTON AVE, Albany, NY 12206-2738
- **Phone:** (518) 689-0282 · **Fax:** (518) 689-0283
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Clinical Social Worker (2), Family Practice (1); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 16, 2012
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1023389533) · Data from the CMS NPPES public registry.