Brenton B Koch, MD

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

31968 Issued in IA

Practice address

4855 Mills Civic Pkwy # 100
West Des Moines, IA 50265-5268

Phone

(515) 277-5555

Fax

(515) 277-0060

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Koch Facial Plastic Surgery PC

  • Otolaryngology Physician
  • West Des Moines, IA
  • NPI 1316389653
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1487651303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 MILLS CIVIC PKWY # 100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502655268",
            "telephone_number": "515-277-5555",
            "fax_number": "515-277-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 MILLS CIVIC PKWY # 100",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502655268",
            "telephone_number": "515-277-5555",
            "fax_number": "515-277-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCH",
        "first_name": "BRENTON",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "IA",
            "license": "31968",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "IA",
            "license": "31968",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "IA",
            "license": "31968",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1162586",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Renee Knight, LMSW
• Patricia Sue Knight, RN
• Angela Knoblauch, DO
• Scott Joseph Knoer, RPH
• Koch Facial Plastic Surgery PC
• Cameron Mansfield Koch, MD
• Cody A Koch, MD, PHD
• Ian Koch, D.O.
• Nathan Koch
• Micaela Marie Koci, MD

• Facial Plastic Surgery Physician in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Facial Plastic Surgery Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.