Douglas A Koekkoek, MD

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

MD16043 Issued in OR

Practice address

4805 NE Glisan St
Ste BG05
Portland, OR 97213-2933

Phone

(503) 215-2393

NPI assigned

Oct 4, 2006

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1275628166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "address_2": "STE BG05",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEKKOEK",
        "first_name": "DOUGLAS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16043",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD16043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE - PH&S - OREGON (PMG)",
            "identifier": "110082876",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046453",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Koehler, P.T.
• Sarah Lynn Koehler, RN
• Victoria Lyn Koehler, LCSW
• Holly Koehmstedt, LMSW
• Shawn Patrick Koehring II, RN
• David Martin Koeller, MD
• Paula H Koeller, MD
• Bree Koenig, LPC
• Mia Lisette Koenig, MA
• Benjamin Lakin Koenigsberg, LMT

• Hospitalist Physician in Portland, OR
• Providers in Portland, OR by specialty
• Hospitalist Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.