Active NPI
Dong Koo, MD
- Anesthesiology Physician
- Danville, IL
National Provider Identifier
1528079688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- Practice address
- 812 N Logan Ave
Danville, IL 61832-3752 - Phone
- (217) 443-5000
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | IL | Primary |
Addresses
Primary practice location
812 N Logan Ave
Danville, IL 61832-3752
Mailing address
PO Box 532904
Atlanta, GA 30353-2904
Phone (217) 443-5000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36062653001 | Medicaid | IL | |
| 9232012 | Other | IL | BCBS |
| DA4244 | Other | IL | RR MEDICARE GROUP |
| P00014471 | Other | IL | RR MEDICARE |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036062653 | IL | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presence Service Corporation | Past | Accepting new patients | |
| Premier Anesthesia of Danville | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Bolingbrook, IL
- NPI 1831204536
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192665600000",
"number": "1528079688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 532904",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303532904",
"telephone_number": "217-443-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "812 N LOGAN AVE",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618323752",
"telephone_number": "217-443-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOO",
"first_name": "DONG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36062653001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "9232012",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "DA4244",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00014471",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.