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NICHOLAS THEODORE KOEN
NPI 1962031856
Internal Medicine in Worcester, MA

Active since April 03, 2020PECOS Enrolled
55 LAKE AVE N, WORCESTER, MA 01655(978) 223-8500 Get Directions Write a Review

NPPES record last updated: December 5, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 5, 2024, Jul 24, 2023, Apr 3, 2020 (3 updates tracked since 2020).

About Nicholas Theodore Koen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS THEODORE KOEN (NPI 1962031856) is an individual internal medicine provider in Worcester, Massachusetts, licensed in Massachusetts (294457) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1962031856
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameNICHOLAS THEODORE KOEN
Location Address55 LAKE AVE NWorcester, MA 01655-0002
Mailing Address55 Lake Ave NWorcester, MA 01655-0002
Phone(978) 223-8500
Sole ProprietorYes
Enumeration DateApril 3, 2020
Last NPPES UpdateDecember 5, 20243 updates tracked since enumeration
NPPES CertifiedDecember 5, 2024
✔ NPI 1962031856 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MA · 294457
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
55 LAKE AVE N, Worcester, MA 01655
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Theodore Koen is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$134.47 typical visit price
range $58.86 – $177.36
Typical copayment $33.61 (range $14.71 – $44.34)
Most-billed visit code 99204
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SARAH BETH SAXER PHARMD
Pharmacist (Pharmacotherapy)
55 LAKE AVE N, UMASS MED CENTER DEPT OF PHARMACY
WORCESTER, MA 01655
Worcester County (508) 856-2763
MARTHA LAROSE SAMPSON CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
LINDA A PAPE M.D.
Internal Medicine (Cardiovascular Disease)
55 LAKE AVE N, CARDIOLOGY
WORCESTER, MA 01655
Worcester County (508) 856-3050
DR. DALE E RAUCH M.D.
Psychiatry & Neurology (Psychiatry)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 856-6580
DR. MAICHI T TRAN PHARM.D.
Pharmacist (Pharmacotherapy)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 856-1618
JESSICA L DOUGLAS MS
Genetic Counselor, MS
55 LAKE AVE N, S1-710
WORCESTER, MA 01655
Worcester County (508) 334-3517
DR. JULIANNE PATRICIA HUBER MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
ELLEN M GRAVALLESE M.D.
Internal Medicine (Rheumatology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-5224

Frequently 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 Nicholas Koen's NPI number?

The NPI number for Nicholas Koen is 1962031856. It was assigned to this individual provider in the NPPES registry on April 3, 2020.

Where is Nicholas Koen located?

Nicholas Koen practices at 55 Lake Ave N, Worcester, MA 01655. The listed phone number is (978) 223-8500.

What is Nicholas Koen's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Nicholas Koen enrolled in Medicare?

Yes. Nicholas Koen is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nicholas Koen was last updated on December 5, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.