Tracey Ann Kopperud, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

O0690 Issued in ID

Practice address

3520 E Louise Dr
Meridian, ID 83642-6304

Phone

(208) 888-0909

Fax

(208) 888-5825

NPI assigned

Jun 17, 2006

Last updated

May 14, 2021By the provider in NPPES

Sex

Female

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

Other names 1

• Tracey A Roehrkasse Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Obstetrics/Gynecology

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

OB-GYN Associates, PAGroup PAC ID 4082519467, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke's Regional Medical Center Hospital, Boise, ID, CCN 130006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tracey.kopperud.p1@direct.obgynidaho.nextgenshare.com

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.

• OB-GYN Associates, PA

  • Obstetrics & Gynecology Physician
  • Meridian, ID
  • NPI 1306816079
  Medicare reassignment Care Compare group NPD
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  Obstetrics & Gynecology

  Medicare reassignment NPD
• T-Medica Mobil Anesthesia Inc.

  • Certified Registered Nurse Anesthetist
  • Meridian, ID
  • NPI 1306588355
  NPD

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

• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1437194388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 E LOUISE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426304",
            "telephone_number": "208-888-0909",
            "fax_number": "208-888-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 E LOUISE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426304",
            "telephone_number": "208-888-0909",
            "fax_number": "208-888-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPERUD",
        "first_name": "TRACEY",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "O0690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK, CLIVE OFFICE",
            "identifier": "21910",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tracey.kopperud.p1@direct.obgynidaho.nextgenshare.com",
            "affiliation": "N",
            "address_1": "3520 E Louise Dr",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "ROEHRKASSE",
            "middle_name": "A",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Misao Komoda, PHARM D
• Gary Koopman, LPC
• Brent D. Kooy, P.A.
• Matthew L Kooyman, DDS
• Ashley Kophs
• Kaley Kosak
• Anne Marie Koster, FNP
• Oleg Sergeevich Kouskov, MD
• Brian Jeffery Kovanda, DMD
• Katherine Elizabeth Kramme, DO

• Obstetrics & Gynecology Physician in Meridian, ID
• Providers in Meridian, ID by specialty
• Obstetrics & Gynecology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.