Active NPI
Jill R Koegel, RD, LMNT, CSSD, CDE
- Registered Dietitian
- Omaha, NE
National Provider Identifier
1174852115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 940
- Practice address
- 17940 Welch PLZ Ste 106
Omaha, NE 68135-3714 - Phone
- (402) 350-8664
- NPI assigned
- Dec 22, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 940 | NE | Primary |
Addresses
Primary practice location
17940 Welch PLZ Ste 106
Omaha, NE 68135-3714
Mailing address
3222 S 187TH St
Omaha, NE 68130-6102
Phone (402) 350-8664
Other practice location 1
11909 Arbor St
Omaha, NE 68144-4400
Phone (402) 350-8664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 940 | NE | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1174852115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3222 S 187TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681306102",
"telephone_number": "402-350-8664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17940 WELCH PLZ STE 106",
"city": "OMAHA",
"state": "NE",
"postal_code": "681353714",
"telephone_number": "402-350-8664"
}
],
"practiceLocations": [
{
"address_1": "11909 Arbor St",
"address_purpose": "LOCATION",
"city": "Omaha",
"state": "NE",
"postal_code": "681444400",
"country_code": "US",
"telephone_number": "402-350-8664",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOEGEL",
"first_name": "JILL",
"middle_name": "R",
"credential": "RD, LMNT, CSSD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-22",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NE",
"license": "940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.