Alyssa Nicole Koopal, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9443 Issued in GA

Practice address

1712A E Broad Ave
Albany, GA 31705-2611

Phone

(229) 639-3100

NPI assigned

Oct 22, 2018

Last updated

Oct 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Albany Area Primary Health Care, IncGroup PAC ID 7911811922, 59 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Albany Area Primary Health Care, Inc.

  dba East Albany Medical Center

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1780608992
  Medicare reassignment Care Compare group
• Phoebe Putney Memorial Hospital Inc

  dba Phoebe Putney Memorial Hosptial

  • General Acute Care Hospital
  • Albany, GA
  • NPI 1992789721
  Medicare reassignment
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment
• Albany Area Primary Health Care, Inc

  dba Radium Springs Middle School-Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1013709625
  NPD
• Phoebe Putney Memorial Hospital

  dba Sickle Cell Clinic

  • Hematology & Oncology Physician
  • Albany, GA
  • NPI 1225072846
  NPD
• Phoebe Putney Memorial Hospital Inc

  dba Phoebe Specialty Pharmacy

  • Community/Retail Pharmacy
  • Albany, GA
  • NPI 1891315420
  NPD
• Albany Area Primary Health Care, Inc.

  dba Lee Health Center

  • Federally Qualified Health Center (FQHC)
  • Leesburg, GA
  • NPI 1568497030
  NPD (past)
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1497221089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 PLANTATION DR",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634284",
            "telephone_number": "310-650-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712A E BROAD AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317052611",
            "telephone_number": "229-639-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOPAL",
        "first_name": "ALYSSA",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "9443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Knighton
• Jordan Knoefler, M.D.
• David Livingstone Kocherla, MD
• Shiny Teja Kolli, MD
• Edward Kojo-Eyiah Koomson, M.D.
• William R Koopal, PA
• Joel John Koshy, DO
• Theresa Libo-on Kowalski, M.D.
• Mika Rivers Krewer, LPC
• Andrea Jane Kromminga

• Physician Assistant in Albany, GA
• Providers in Albany, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.