Active NPI
Theodore A.W. Koerner Jr., MD
- Occupational Medicine Physician
- Iowa City, IA
National Provider Identifier
1356397202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- MD-25617
- Practice address
- 23 Penfro Dr Ste 2
Iowa City, IA 52246 - Phone
- (319) 330-7667
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | 1095 | WI | |
| Family Medicine Physician | 207Q00000X | 25617 | IA | |
| Occupational Medicine Physician | 2083X0100X | MD-25617 | IA | Primary |
Addresses
Primary practice location
23 Penfro Dr Ste 2
Iowa City, IA 52246
Mailing address
PO Box 2551
Iowa City, IA 52244-2551
Phone (319) 688-9045
Other practice location 1
1720 Central Ave E
Hampton, IA 50441-1859
Phone (641) 456-4721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-25617 | IA | MD | Occupational Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611792000000",
"number": "1356397202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2551",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522442551",
"telephone_number": "319-688-9045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 PENFRO DR STE 2",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "52246",
"telephone_number": "319-330-7667"
}
],
"practiceLocations": [
{
"address_1": "1720 Central Ave E",
"address_purpose": "LOCATION",
"city": "Hampton",
"state": "IA",
"postal_code": "504411859",
"country_code": "US",
"telephone_number": "641-456-4721",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOERNER",
"first_name": "THEODORE",
"middle_name": "A.W.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2021-01-28",
"certification_date": "2021-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "WI",
"license": "1095",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "25617",
"primary": false
},
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "IA",
"license": "MD-25617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.