CLINT JEREMY KOENIG (MD) – Family Medicine Physician, NPI 1124000781
Family Medicine Physician
Main info
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for CLINT JEREMY KOENIG (MD)
Riverside Family Practice Center, 697, Thomas Lane, Olentangy West, Columbus, Sharon, Franklin, Ohio, 43214, United States
COLUMBUS, OH 432143931
Phone: (614) 566-5414
Fax: (614) 533-0433
Type: Location
777 Clinton Ave S
Rochester, NY 146201448
Phone: (585) 279-4800
Fax: (585) 442-8319
Type: Location
Frantz Road, Dublin, Franklin, Ohio, 43017, United States
DUBLIN, OH 430164141
Phone: (614) 533-6497
Fax: (614) 544-6370
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-12-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041202001000 | I | Family Practice | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43214)
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