Jacqueline M Koski, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101018350 Issued in MI

Practice address

163 E North Water St
Neenah, WI 54956-2708

Phone

(920) 215-0022

Fax

(920) 921-3500

NPI assigned

Jul 1, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 25, 2023 through Apr 25, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Mercy Urgent Care

  • Urgent Care Clinic/Center
  • Muskegon, MI
  • NPI 1861432692

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1417185232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 EMERSON ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549564674",
            "telephone_number": "920-215-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 E NORTH WATER ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562708",
            "telephone_number": "920-215-0022",
            "fax_number": "920-921-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSKI",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "59923-21",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101018350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Mary Kokontis, MD
• Scott C Kolbeck, M.D.
• Katy Kolgen, COTA
• Mary Colleen Kollberg, MSW
• Sherry Lynn Konen, APNP
• Sawyer Kossl, APNP
• Emily Rose Kotloski, RN
• Jon C Kralik, M.D.
• James Scott Kramer, D.D.S.
• Stephanie Lynn Kramer, D.D.S.

• Family Medicine Physician in Neenah, WI
• Providers in Neenah, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.