Individual provider Active NPI

Kevin Scott Koehler, M.D.

  • Emergency Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1417116229
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101245991 Issued in VA
Practice address
3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone
(314) 238-5260
Fax
(314) 821-1833
NPI assigned
Jun 6, 2008
Last updated
Oct 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0101245991 VA Primary

Addresses

Primary practice location

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013

Mailing address

PO Box 75332
Charlotte, NC 28275-0332
Phone (314) 238-5260

Other practice location 1

620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (704) 616-1919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20141022000273 NC Practitioner - Emergency Medicine 7416190103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Brody School of Medicine at East Carolina University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Emergency Services, P.a.Group PAC ID 1153358171, 24 clinicians

Practice addresses (Care Compare)

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 765-9328

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.52 of 100Reported as group
Quality
83.13
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Emergency Services, P.a. Emergency Medicine CurrentSince Mar 1, 2016 Accepting new patients
North Carolina Em I Medical Services P C Past Accepting new patients
Riverside Physician Services, Inc. Emergency Medicine Past Accepting new patients

Locations

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1417116229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75332",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282750332",
            "telephone_number": "314-238-5260",
            "fax_number": "314-821-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "314-238-5260",
            "fax_number": "314-821-1833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 John Paul Jones Cir",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237082111",
            "country_code": "US",
            "telephone_number": "704-616-1919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEHLER",
        "first_name": "KEVIN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101245991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.