Kelly Marie Kopkowski, DO

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

OS013485 Issued in PA

Practice address

2501 W 12TH St Ste C10
Erie, PA 16505-4527

Phone

(814) 580-5600

Fax

(814) 455-2584

NPI assigned

Sep 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkopkowski153956@direct.ahn.org

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.

• Lake Erie Medical Group PC

  • Internal Medicine Physician
  • Erie, PA
  • NPI 1053696997

  Physical Medicine & Rehabilitation

  Medicare reassignment NPD
• Erie Physicians Network PC

  • Multi-Specialty Clinic/Center
  • Erie, PA
  • NPI 1902844574
  NPD (past)

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1386839405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST STE C10",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-580-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 12TH ST STE C10",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054527",
            "telephone_number": "814-580-5600",
            "fax_number": "814-455-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPKOWSKI",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-11",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "OS013485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BCBS",
            "identifier": "002052642",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026864670001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkopkowski153956@direct.ahn.org",
            "affiliation": "N",
            "address_1": "2501 W 12th St Ste C10",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165054527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victoria Konzel, PA-C
• Cosmi Lynne Konzelman, LCSW, CCTP
• Alyssa Koons
• Aric Kopf, PT
• Kathryn Marie Kopf, PT
• Divya Koradia, MD
• Nishant Koradia, M.D.
• Tammy Lynn Kordes, PH.D.
• Emily Louise Koscienski, BS
• Alexander Kosenko, M.D.

• Physical Medicine & Rehabilitation Physician in Erie, PA
• Providers in Erie, PA by specialty
• Physical Medicine & Rehabilitation Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.

Verify at the official NPI Registry.