Renee L.G. Koffend, AU.D., CCC-A
Individual provider Active NPI Audiologist · Tamuning, GU
NPI 1083715684 · NPPES record last updated Dec 13, 2016
Key facts
- NPI
- 1083715684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- 1601000192 (MI)
- Practice address
- 341 S Marine Corps Dr
R.K. Plaza, Suite 101B
Tamuning, GU 96913-3970 - Phone
- (671) 989-8378
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Qualified Audiologist
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
341 S Marine Corps Dr
Suite 101B
Tamuning, GU 96913-3970
Phone (671) 687-1327
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117002611 | GU | Practitioner - Qualified Audiologist | 9436252798 | Practice locations: Tamuning, GU |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601000192 | MI | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presence Healthcare Services | Past | Accepting new patients | |
| Head & Neck Cosmetic Surgery Associates LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000192 | MI | Yes |
Addresses
Primary practice location
341 S Marine Corps Dr
R.K. Plaza, Suite 101B
Tamuning, GU 96913-3970
Mailing address
341 S Marine Corps Dr
R.K. Plaza, Suite 101B
Tamuning, GU 96913-3970
Phone (671) 989-8378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1062 | Medicaid | GU |
Other providers in Tamuning, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.