Active NPI
Stephanie R. Koos, D.O.
- Family Medicine Physician
- Waverly, IA
National Provider Identifier
1508066721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 3923
- Practice address
- 312 9TH St SW
Suite 1200
Waverly, IA 50677-2929 - Phone
- (319) 352-4340
- Fax
- (319) 352-0745
- NPI assigned
- Jul 25, 2007
- Last updated
- Sep 7, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R-8116 | IA | |
| Family Medicine Physician | 207Q00000X | 3923 | IA | Primary |
Addresses
Primary practice location
312 9TH St SW
Suite 1200
Waverly, IA 50677-2929
Mailing address
312 9TH St SW
Suite 1200
Waverly, IA 50677-2929
Phone (319) 352-4340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508066721 | Medicaid | IA |
Other names 1
- Stephanie R. Wilson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3923 | IA | MD | Family Medicine Physician |
| R-8116 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Floyd County Memorial Hospital Commission | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
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- NPI 1265402390
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283817600000",
"number": "1508066721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 9TH ST SW",
"address_2": "SUITE 1200",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506772929",
"telephone_number": "319-352-4340",
"fax_number": "319-352-0745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 9TH ST SW",
"address_2": "SUITE 1200",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506772929",
"telephone_number": "319-352-4340",
"fax_number": "319-352-0745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOS",
"first_name": "STEPHANIE",
"middle_name": "R.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2010-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "R-8116",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "3923",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1508066721",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "WILSON",
"middle_name": "R.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waverly, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.