Active NPI
Drew Koeppl, CPNP-AC
- Critical Care Pediatric Nurse Practitioner
- Milwaukee, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Pediatric Nurse Practitioner
- License
- 6493
- Practice address
- 9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874 - Phone
- (414) 266-3690
- Fax
- (414) 266-3676
- NPI assigned
- Feb 26, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 6493 | WI | |
| Critical Care Pediatric Nurse Practitioner | 363LP0222X | 209011077 | IL | |
| Critical Care Pediatric Nurse Practitioner | 363LP0222X | 6493 | WI | Primary |
Addresses
Primary practice location
9000 W Wisconsin Ave
Pediatric Gastroenterology
Milwaukee, WI 53226-4874
Mailing address
835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 496-4700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6493 | WI | MD | Dental Hygienist |
| 209011077 | IL | MD | Critical Care Pediatric Nurse Practitioner |
| 209001077 | IL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Vincent Hospital-Hospital Sisters-Third Order of St Francis | Current | Accepting new patients | |
| St. Nicholas Hospital-Sisters of the Third Order of St Francis | Current | Accepting new patients | |
| St Vincent Hospital-Hospital Sisters-Third Order of St Francis | Current | Accepting new patients | |
| St Nicholas Hospital-Sisters of the Third Order of St Francis | Current | Accepting new patients | |
| St Vincent Hospital-Hospital Sisters-Third Order of St Francis | Past | Accepting new patients |
Locations
835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246
3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710
Organizations & group practices 5
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.
-
dba Prevea Health
- General Practice Physician
- Green Bay, WI
- NPI 1285613638
-
dba Prevea Sheboygan Health Center
- Internal Medicine Physician
- Sheboygan, WI
- NPI 1275799413
-
dba St. Nicholas Hospital
- Internal Medicine Physician
- Sheboygan, WI
- NPI 1447737762
-
dba Prevea Health
- Durable Medical Equipment & Medical Supplies
- Green Bay, WI
- NPI 1245042530
-
dba St Vincent Hospital Clinic
- Gynecologic Oncology Physician
- Green Bay, WI
- NPI 1316991169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548979200000",
"number": "1033534169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 S VAN BUREN ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013526",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE",
"address_2": "PEDIATRIC GASTROENTEROLOGY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264874",
"telephone_number": "414-266-3690",
"fax_number": "414-266-3676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEPPL",
"first_name": "DREW",
"credential": "CPNP-AC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-26",
"last_updated": "2019-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WI",
"license": "6493",
"primary": false
},
{
"code": "363LP0222X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics, Critical Care",
"state": "IL",
"license": "209011077",
"primary": false
},
{
"code": "363LP0222X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics, Critical Care",
"state": "WI",
"license": "6493",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.