Kenyn L. Koop, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

86593 Issued in SC

Practice address

849 Kellogg Ave
Janesville, WI 53546-2808

Phone

(608) 755-7960

NPI assigned

Aug 8, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Coastal Carolina Health Care PAGroup PAC ID 9739087693, 122 clinicians

Broad River RehabilitationGroup PAC ID 3375801350, 210 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Pollocksville, NC, CCN 347333
• Pruitthealth Home Health New Bern Home health agency, New Bern, NC, CCN 347026
• 3HC Home health agency, Goldsboro, NC, CCN 347104
• Carolina East Medical Center Hospital, New Bern, NC, CCN 340131

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkoop27239@coastalcarolinahealthcenter.gardenplot.direct-ci.com

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.

• Coastal Carolina Health Care PA

  • Internal Medicine Physician
  • New Bern, NC
  • NPI 1750567970
  Medicare reassignment Care Compare group NPD
• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment NPD
• Broad River Rehabilitation

  • Occupational Therapist
  • Charlotte, NC
  • NPI 1902317589
  Care Compare group
• Coastal Carolina Health Care PA

  • Family Medicine Physician
  • New Bern, NC
  • NPI 1366498297
  NPD
• Coastal Carolina Health Care PA

  • Internal Medicine Physician
  • New Bern, NC
  • NPI 1780623207
  NPD
• Coastal Carolina Health Care PA

  • Family Medicine Physician
  • Morehead City, NC
  • NPI 1821959610
  NPD
• Prisma Health University Medical Group

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Prisma Health University Medical Group

  • Family Medicine Physician
  • Easley, SC
  • NPI 1295218642
  NPD

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

• Carolinaeast Medical Center

  • General Acute Care Hospital
  • New Bern, NC
  • NPI 1801852835
  Care Compare affiliation
• Home Health and Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Goldsboro, NC
  • NPI 1558396622

  Home health agency

  Care Compare affiliation
• Home Health and Hospice Care, Inc.

  • Home Health Agency
  • Goldsboro, NC
  • NPI 1750337366
  Care Compare affiliation
• Pruitthealth Home Health, Inc.

  • Home Health Agency
  • New Bern, NC
  • NPI 1891197380
  Care Compare affiliation
• Tar Heel Health Care Services, LLC

  • Home Health Agency
  • Pollocksville, NC
  • NPI 1043243835
  Care Compare affiliation

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1124507439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "849 KELLOGG AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535462808",
            "telephone_number": "608-755-7960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 Whitetail Dr",
            "address_purpose": "LOCATION",
            "city": "Walhalla",
            "state": "SC",
            "postal_code": "296915837",
            "country_code": "US",
            "telephone_number": "864-638-3444",
            "fax_number": "864-638-3445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOOP",
        "first_name": "KENYN",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-08",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": "7185-851",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "86593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher M. Koenig, DO
• David Kohlmeyer, LPC
• Lauren Kolar, SLP
• Benno W Kollmansberger, LCSW, LPC
• Keith Konkol, MD
• Mitchell A Kopnick, MD
• Michael M. Korbol, P.A.
• Cassi Leann Kornely
• Tina L. Kosnar, MD
• Maria Kostantacos, APRN, FNP

• Family Medicine Physician in Janesville, WI
• Providers in Janesville, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.