NPIMap

Individual provider Active NPI

William Markus Koeppel, D.O.

  • Family Medicine Physician
  • Ellisville, MO
National Provider Identifier
1194162883
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2022017094 Issued in MO
Practice address
225 Clarkson Rd
Ellisville, MO 63011-2278
Phone
(706) 865-4001
Fax
(706) 865-6268
NPI assigned
Jun 4, 2013
Last updated
Aug 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 076204 GA
Family Medicine Physician 207Q00000X 2022017094 MO Primary

Addresses

Primary practice location

225 Clarkson Rd
Ellisville, MO 63011-2278

Mailing address

PO Box 657
Suite a
Demorest, GA 30535-0657
Phone (660) 723-3915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160804000750 GA Practitioner - Family Practice 5799900627 Reassigns benefits to 1 organization
I20220829001299 MO Practitioner - Family Practice 5799900627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Westglen Family Physicians LLCGroup PAC ID 3678506102, 8 clinicians

Practice addresses (Care Compare)

15425 Manchester Rd
Ballwin, MO 63011-3077
Phone (636) 220-6969

225 Clarkson Rd
Ellisville, MO 63011-2278
Phone (636) 685-7715

653 Big Bend Rd
Manchester, MO 63021-7723
Phone (636) 685-7770

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
076204GAMDFamily Medicine Physician
2022017094MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westglen Family Physicians, LLC Family Medicine CurrentSince Jun 20, 2022 Accepting new patients
The Hospital Authority of Habersham County CurrentSince Jul 21, 2016 Accepting new patients
The Hospital Authority of Habersham County Current Accepting new patients

Locations

17 White St
Cleveland, GA 30528
Phone (706) 865-4001

541 441 Historic Hwy N
Demorest, GA 30535
Phone (706) 839-4000

225 Clarkson Rd
Ellisville, MO 63011
Phone (636) 230-5050

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1194162883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 657",
            "address_2": "SUITE A",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "305350657",
            "telephone_number": "660-723-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CLARKSON RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112278",
            "telephone_number": "706-865-4001",
            "fax_number": "706-865-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEPPEL",
        "first_name": "WILLIAM",
        "middle_name": "MARKUS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-04",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "076204",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2022017094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

Verify at the official NPI Registry.