Michael Adam Koeppe, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

682 Issued in ND

Practice address

3232 13TH Ave S
Fargo, ND 58103

Phone

(701) 280-3000

Fax

(701) 280-1304

NPI assigned

Jul 19, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fargo Vision Associates PCGroup PAC ID 7517926223, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Fargo Vision Associates, P.C.

  • Eyewear Supplier
  • Fargo, ND
  • NPI 1659326205
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1247961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1407086960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3232 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-280-3000",
            "fax_number": "701-280-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-280-3000",
            "fax_number": "701-280-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEPPE",
        "first_name": "MICHAEL",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-19",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "N714659",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tylor Kock, D.O.
• Nikole Lee Koehn, MATRG, ATC
• Alissa Koenig, DPT
• Mikayla Koenig, RDN, LRD
• Libbi Koeppe
• Crystal Marie Koepplin, RN
• Jeremy Koepplin, PT, DPT
• Julie Ann Koerner, OTR/L
• Katrina J Koesterman
• Alexandra D Kohlhase, PSYD

• Optometrist in Fargo, ND
• Providers in Fargo, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.
• 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.