Individual provider Active NPI

Morgan R Koffke, NP

  • Nurse Practitioner
  • Appleton, WI
National Provider Identifier
1487220042
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11045 Issued in WI
Practice address
2000 E Milestone Dr
Appleton, WI 54913-6701
Phone
(920) 731-8131
Fax
(920) 832-0444
NPI assigned
Jun 2, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11045-33 WI
Nurse Practitioner 363L00000X 11045 WI Primary
Registered Nurse 163W00000X 232618 WI

Addresses

Primary practice location

2000 E Milestone Dr
Appleton, WI 54913-6701

Mailing address

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Other names 1

  • Morgan R Phillip Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210914002656 WI Practitioner - Nurse Practitioner 5991101099 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Surgical Associates LTDGroup PAC ID 7911971296, 35 clinicians

Practice addresses (Care Compare)

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
232618WIMDRegistered Nurse
11045WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Valley Surgical Associates LTD CurrentSince Jul 13, 2022 Accepting new patients
Thedacare, Incorporated CurrentSince Jul 15, 2021 Accepting new patients
Thedacare, Incorporated CurrentSince Jul 15, 2021 Accepting new patients

Locations

2500 E Capitol Dr
Appleton, WI 54911
Phone (920) 738-4600

2000 E Milestone Dr
Appleton, WI 54913
Phone (920) 358-1729

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

130 2nd St
Ste 197
Neenah, WI 54956
Phone (920) 729-2030

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1487220042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131",
            "fax_number": "920-832-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131",
            "fax_number": "920-832-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFKE",
        "first_name": "MORGAN",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "11045-33",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "11045",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "232618",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MORGAN",
            "last_name": "PHILLIP",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.