Richard Bruce Koefoot, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

18143 Issued in NE

Practice address

620 N Alpha St
Grand Island, NE 68803-4316

Phone

(308) 381-0473

Fax

(308) 381-2616

NPI assigned

Jan 18, 2006

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/e699c25a-4b9f-4771-9576-e790a1116e0f/

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.

• Cambridge Memorial Hospital Inc

  • Family Medicine Physician
  • Cambridge, NE
  • NPI 1740462654
  NPD
• Leconte Women'S Healthcare Associates, PC

  • Obstetrics & Gynecology Physician
  • Sevierville, TN
  • NPI 1053347492
  NPD (past)

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264636800000",
    "number": "1003896010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034316",
            "telephone_number": "308-381-0473",
            "fax_number": "308-381-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034316",
            "telephone_number": "308-381-0473",
            "fax_number": "308-381-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEFOOT",
        "first_name": "RICHARD",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2010-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NE",
            "license": "18143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00378",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "247460",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00241093",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Knehans
• Timothy D Knudsen, M.D.
• Nyaber Koang
• Kurt Kenneth Koch, PA-C
• Alicia Ann Kochheiser
• Heather Nicole Koehlmoos, OTR/L
• Aldo Koentjoro, D.D.S
• Avery Kohl
• Chantal Kohl
• Rachel Sarah Kohlman, PLMHP

• Specialist in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Specialist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.