Nathaniel Koo

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

036133774 Issued in IL

Practice address

840 S Wood St
Suite 518-E
Chicago, IL 60612-4325

Phone

(312) 996-6765

NPI assigned

Apr 14, 2008

Last updated

Apr 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nkoo17192@uihealth.direct-ci.com
• Direct secure messaging: nkoo187009@direct.rush.rush-health.com
• Direct secure messaging: nkoo222200@direct.edward.org
• Direct secure messaging: nkoo276122@direct.myadvocateaurora.org

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.

• Bonaventure Medical Foundation, LLC

  dba Alexian Brothers Medical Foundation

  • Family Medicine Physician
  • Elk Grove Village, IL
  • NPI 1588775647
  Medicare reassignment NPD
• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment NPD
• Rush University Medical Group

  dba Rush University Internists

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542

  Surgery

  Medicare reassignment NPD
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Chicago, IL
  • NPI 1871930693
  Medicare reassignment NPD
• Endeavor Health Medical Group

  dba NorthShore Anesthesia Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Rush University Medical Center

  dba Radiology Services

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1184269425
  NPD
• Shriners Hospitals for Children

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1326536574
  NPD
• Shriners Hospitals for Children

  dba Shriners Children's Hawaii

  • Clinic/Center
  • Aiea, HI
  • NPI 1568299857
  NPD
• Wyse Eyecare SC

  • Ophthalmology Physician
  • Northbrook, IL
  • NPI 1316272289
  NPD (past)
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1568803732
  NPD (past)

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1467626184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 N WOOD ST UNIT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223261",
            "telephone_number": "847-903-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "SUITE 518-E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-996-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "NATHANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036133774",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IL",
            "license": "036133774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nathaniel.koo@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dedeepya Konuthula, M.D.
• Mackenzie Konz
• Paul L Konz, LCPC
• Alexander Il Joung Koo, MD
• Jah-Won Koo, M.D.
• Erin Nicole Kooiker, PTA
• Joanna Marie Kooistra, M.S., BCBA
• Melissa Koontz
• Rory Koontz, LPC
• Aita Koopahi

• Pediatric Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.