Individual provider Active NPI

Brenna Ann Koch, PA-C

  • Physician Assistant
  • Elgin, IL
National Provider Identifier
1609655026
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085011028 Issued in IL
Practice address
1550 N Randall Rd
Elgin, IL 60123-7876
Phone
(815) 398-9491
Fax
(815) 381-7498
NPI assigned
Sep 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085011028 IL Primary

Addresses

Primary practice location

1550 N Randall Rd
Elgin, IL 60123-7876

Mailing address

PO Box 735263
Chicago, IL 60673-5263
Phone (815) 484-6945

Other practice location 1

650 S Randall Rd
Algonquin, IL 60102-5944
Phone (815) 398-9491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20250110002547 IL Practitioner - Physician Assistant 8123556677 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

1550 N Randall Rd
Elgin, IL 60123-7876
Phone (815) 398-9491

650 S Randall Rd
Algonquin, IL 60102-5944
Phone (815) 381-7431

770 Beloit Rd
Belvidere, IL 61008-1745
Phone (815) 398-9491

Hospital & facility affiliations

  • Advocate Sherman Hospital Hospital, Elgin, IL, CCN 140030
  • Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
  • Saint Joseph Hospital-Elgin Hospital, Elgin, IL, CCN 140217

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085011028ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthomidwest, PLLC CurrentSince Jan 9, 2025 Accepting new patients
Orthomidwest, PLLC Physician Assistant CurrentSince Jan 9, 2025 Accepting new patients

Locations

650 S Randall Rd
Algonquin, IL 60102
Phone (779) 771-7000

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

1550 N Randall Rd
Elgin, IL 60123
Phone (815) 569-6355

535 Roxbury Rd
Rockford, IL 61107
Phone (815) 387-1717

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1609655026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735263",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735263",
            "telephone_number": "815-484-6945",
            "fax_number": "815-381-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237876",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 S Randall Rd",
            "address_purpose": "LOCATION",
            "city": "Algonquin",
            "state": "IL",
            "postal_code": "601025944",
            "country_code": "US",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOCH",
        "first_name": "BRENNA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085011028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.