Theresa Koppal, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5748 Issued in AZ

Practice address

2940 E Banner Gateway Dr Ste 200-250
Gilbert, AZ 85234-2168

Phone

(602) 548-5444

Fax

(602) 772-3801

NPI assigned

Sep 15, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic Specialists of North America PLLCGroup PAC ID 7719014505, 310 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arizona Spine and Joint Hospital Hospital, Mesa, AZ, CCN 030107

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theresakoppal@asjh.medalliesdirect.net

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.

• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1770812828
  Medicare reassignment Care Compare group NPD (past)
• Arizona Spine and Joint Hospital LLC

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1396745832
  NPD
• Orthopedic Specialists of North America PLLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1740636315
  NPD
• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Gilbert, AZ
  • NPI 1962292870
  NPD
• District Medical Group, Inc

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1295968162
  NPD (past)
• Sports & Orthopaedic Specialists of Arizona LLC

  • Orthopaedic Surgery Physician
  • Gilbert, AZ
  • NPI 1447381488
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Arizona Spine and Joint Hospital LLC

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1396745832
  Care Compare affiliation

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1033510508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80217",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850600217",
            "telephone_number": "602-385-2115",
            "fax_number": "480-418-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 E BANNER GATEWAY DR STE 200-250",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342168",
            "telephone_number": "602-548-5444",
            "fax_number": "602-772-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPAL",
        "first_name": "THERESA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-15",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5748",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia L Kooima, M.D.
• Jessica Kooima, NMD
• Deborah Lynn Kooiman, OTR/L
• Callie Koons
• Kope Mental Health and Wellness Services PLLC
• Nathan Thomas Korczynski, PHARMD
• Holly L Korica, WHNP-BC
• Joshua Korson, DPT
• Anna Kortsen Kortsen, LMSW
• Sara Korzeniewski, R.D.

• Physician Assistant in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.