Matt E Koepke, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4011 Issued in WV

Practice address

198 Rutledge Avenue
Suite 4
Charleston, SC 29403

Phone

(843) 853-5859

Fax

(843) 853-5861

NPI assigned

Jul 9, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Shelbourne & Associates Oral and Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charleston, SC
  • NPI 1730602319
  NPD (past)

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1386909109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVENUE",
            "address_2": "SUITE 4",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-853-5859",
            "fax_number": "843-853-5861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 RUTLEDGE AVENUE",
            "address_2": "SUITE 4",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-853-5859",
            "fax_number": "843-853-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEPKE",
        "first_name": "MATT",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "4011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Glenn Koch, M.D.
• Frances Rowinsky Koch, MD
• Jason K Koch, PSYD
• Thomas Kenneth Koch, MD
• Samantha Gail Kodak, RN, CCRN, SRNA
• Breanna Marie Koetter, MD
• Madison Koger
• Amanda B. Kogos, MD
• Mallory M Kohari
• Matthew Kohler, MD

• Oral and Maxillofacial Surgery (Dentist) in Charleston, SC
• Providers in Charleston, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.