NPIMap

Individual provider Active NPI

Seth Tyler Koehler, D.O.

  • Family Medicine Physician
  • Jackson, MO
National Provider Identifier
1255782843
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2018007982 Issued in MO
Practice address
2600 E Main St
Jackson, MO 63755-2473
Phone
(573) 755-2310
Fax
(573) 519-4675
NPI assigned
Jun 25, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2018007982 MO Primary

Addresses

Primary practice location

2600 E Main St
Jackson, MO 63755-2473

Mailing address

2600 E Main St
Jackson, MO 63755-2473
Phone (573) 755-2310

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181203000133 MO Practitioner - Family PracticePractitioner - Emergency Medicine 3577854108 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Facilities Rehab Services IncGroup PAC ID 3476679226, 152 clinicians
Southeast Missouri Health NetworkGroup PAC ID 6507818044, 19 clinicians

Practice addresses (Care Compare)

1102 Sikes Ave
Sikeston, MO 63801-5021

200 Southland Dr
Sikeston, MO 63801-4403
Phone (573) 472-1770

Hospital & facility affiliations

  • Adoration Home Health Home health agency, Sikeston, MO, CCN 267499
  • Crown Hospice Hospice, Poplar Bluff, MO, CCN 261681
  • Missouri Delta Medical Center Hospital, Sikeston, MO, CCN 260113
  • Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
  • Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
  • Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018007982MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Missouri Health Network CurrentSince Jan 1, 2024 Accepting new patients
Southeast Health Center of Stoddard County LLC Family Medicine CurrentSince Oct 5, 2018 Accepting new patients
Southeast Missouri Health Network CurrentSince Jan 1, 2024 Accepting new patients
Southeast Missouri Health Network Current Accepting new patients
Southeast Hospital Current Accepting new patients
Southeast Health Center of Stoddard County, LLC Family Medicine Current Accepting new patients
Southeast Missouri Hospital Physicians, LLC Family Medicine CurrentSince Aug 1, 2019 Accepting new patients
Southeast Health Center of Stoddard County, LLC Family Medicine CurrentSince Oct 5, 2018 Accepting new patients
Southeast Missouri Health Network Past Accepting new patients
Physician Specialists of St Lukes LLC Family Medicine Past Accepting new patients

Locations

6724 State Highway 77
Benton, MO 63736
Phone (573) 545-4191

817 S Mount Auburn Rd
Cape Girardeau, MO 63703
Phone (573) 519-4500

109 E 5th St
Caruthersville, MO 63830
Phone (573) 359-9803

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

2600 E Main St
Jackson, MO 63755
Phone (573) 331-6157

200 Pine St
Sikeston, MO 63801
Phone (573) 313-2500

200 Southland Dr
Sikeston, MO 63801
Phone (573) 472-1770

Interoperability endpoints

  • Direct secure messaging: seth.koehler.1@14764.direct.athenahealth.com

Organizations & group practices 11

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.

Hospital & facility affiliations 7

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": "1466812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1255782843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E MAIN ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552473",
            "telephone_number": "573-755-2310",
            "fax_number": "573-519-4675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E MAIN ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552473",
            "telephone_number": "573-755-2310",
            "fax_number": "573-519-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEHLER",
        "first_name": "SETH",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-25",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2018007982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MO

Sources for this page

Verify at the official NPI Registry.