Koch Family Medicine SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KOCH FAMILY MEDICINE SC

Practice address

411 Maxine Dr
Morton, IL 61550-2495

Phone

(309) 263-2411

NPI assigned

Apr 4, 2007

Last updated

Oct 20, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stanley Koch, M.D.NPI 1467436436

Title

Physician

Phone

(309) 263-2411

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stanley W Koch, MD

  • Family Medicine Physician
  • Morton, IL
  • NPI 1467436436
  Medicare reassignment Care Compare group NPD Authorized official
• Shelby Laine Fehr, APRN

  • Family Nurse Practitioner
  • Peoria, IL
  • NPI 1184190613
  Medicare reassignment Care Compare group NPD
• Kimberly Yvette Ford, D.O.

  • Family Medicine Physician
  • Morton, IL
  • NPI 1275724866
  Medicare reassignment Care Compare group NPD
• Mary E Gerig, P. T.

  • Physical Therapist
  • Peoria, IL
  • NPI 1487772448
  Medicare reassignment Care Compare group NPD
• Angela J Gilles, MSFNP

  • Family Nurse Practitioner
  • Morton, IL
  • NPI 1770539611
  Medicare reassignment Care Compare group NPD
• Rose Hoerr

  • Physical Therapist
  • Peoria, IL
  • NPI 1699214338
  Medicare reassignment Care Compare group NPD
• Mary Katherine Imig, DO

  • Family Medicine Physician
  • Morton, IL
  • NPI 1912492448
  Medicare reassignment Care Compare group NPD
• Matthew A Kresnicka, DPT

  • Physical Therapist
  • Bloomington, IL
  • NPI 1134690522
  Medicare reassignment Care Compare group NPD
• Jonathan Acklie, PT

  • Physical Therapist
  • Peoria, IL
  • NPI 1568437747
  Medicare reassignment NPD
• Brian Staniszewski, P.T.

  • Physical Therapist
  • Peoria, IL
  • NPI 1558501106
  Medicare reassignment NPD

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1376665125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495",
            "telephone_number": "309-263-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOCH FAMILY MEDICINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "309-263-2411",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036060959",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1467436436",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Wayne Kinsinger, D.D.S.
• Kelsey Kirk
• Cristol S Klicker, LCSW
• Matthew Knight
• Kathy Knochel, M.S.W.
• Jennifer Koch, PTA
• Stanley W Koch, MD
• Amy Marie Kominkiewicz, RN, IBCLC
• Nathan Krahn, LCPC
• Krueger & Associates LLC

• Family Medicine Physician in Morton, IL
• Providers in Morton, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.