Individual provider Active NPI

Emma Colette Koesters, MD

  • Plastic and Reconstructive Surgery Physician
  • Chicago, IL
National Provider Identifier
1295197796
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
036.160267 Issued in IL
Practice address
5841 S Maryland Ave RM J461
Chicago, IL 60637-1443
Phone
(323) 442-7903
NPI assigned
Mar 23, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 036.160267 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave RM J461
Chicago, IL 60637-1443

Mailing address

150 Harvester Dr Ste 300
Burr Ridge, IL 60527-5965

Other names 1

  • Emma David Vartanian Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230822004187 CA Practitioner - Plastic and Reconstructive Surgery 5294136800 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1450 San Pablo St
Los Angeles, CA 90033-4500

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8444

1516 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1808 Verdugo Blvd
Suite 209
Glendale, CA 91208-1413
Phone (818) 236-4540

1812 Verdugo Blvd
Glendale, CA 91208-1407
Phone (818) 790-7100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy31
Melanoma (skin cancer) excision23
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.160267ILMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2023 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2023 Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1808 Verdugo Blvd
Ste 209
Glendale, CA 91208
Phone (818) 949-4494

1200 N State St
Ste A7D
Los Angeles, CA 90089
Phone (323) 409-5555

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1295197796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR STE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE RM J461",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "323-442-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOESTERS",
        "first_name": "EMMA",
        "middle_name": "COLETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036.160267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMMA",
            "last_name": "VARTANIAN",
            "middle_name": "DAVID",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.