Individual provider Active NPI

Monique Elizabeth Koechlin

  • Physician Assistant
  • Vallejo, CA
National Provider Identifier
1609440890
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
61357 Issued in CA
Practice address
1310 Club Dr
Vallejo, CA 94592-1187
Phone
(707) 638-5809
NPI assigned
May 13, 2021
Last updated
Jan 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 61357 CA Primary

Addresses

Primary practice location

1310 Club Dr
Vallejo, CA 94592-1187

Mailing address

125 Ken CT
Vallejo, CA 94591-4214
Phone (571) 275-4931

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20230125000703 CA Practitioner - Physician Assistant 9436520749 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
97.92 of 100Reported as group
Quality
87.42
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61357CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California CurrentSince Jan 15, 2023 Accepting new patients
Cep America - California CurrentSince Jan 15, 2023 Accepting new patients
Cep America - California CurrentSince Jan 15, 2023 Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Interoperability endpoints

  • Direct secure messaging: mkoechlin610139@hisp.ehr.sutterhealth.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1609440890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 KEN CT",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945914214",
            "telephone_number": "571-275-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 CLUB DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945921187",
            "telephone_number": "707-638-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOECHLIN",
        "first_name": "MONIQUE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "61357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.