NPIMap

Individual provider Active NPI

Andrew Jon Kopperud, MD

  • Internal Medicine Physician
  • Westbrook, MN
National Provider Identifier
1629294533
Registry record updated Mar 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
53376 Issued in MN
Practice address
920 Bell Ave
Westbrook, MN 56183-9669
Phone
(507) 274-6121
NPI assigned
Apr 18, 2007
Last updated
Mar 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57010337 OH
Internal Medicine Physician 207R00000X 53376 MN Primary
Pediatrics Physician 208000000X 53376 MN
Pediatrics Physician 208000000X 35089804 OH

Addresses

Primary practice location

920 Bell Ave
Westbrook, MN 56183-9669

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akopperud1003818@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110210001068 MN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 0345392957 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Minnesota Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health NetworkGroup PAC ID 6800707100, shared by 49 NPIs, 357 clinicians

Practice addresses (Care Compare)

112 Saint Olaf Ave S
Canby, MN 56220-1433
Phone (507) 223-7277

249 5TH St E
Tracy, MN 56175-1536
Phone (507) 629-8400

251 5TH St E
Tracy, MN 56175-1536
Phone (507) 629-8400

308 8TH St N
Mountain Lake, MN 56159-1568
Phone (507) 427-3332

920 Bell Ave
Westbrook, MN 56183-9669
Phone (507) 274-1150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.53 of 100Reported as group
Quality
80.98
Promoting interoperability
100
Improvement activities
40
Cost
70.78

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53376MNMDInternal Medicine Physician
57010337OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network Current Accepting new patients
Sanford Health Network CurrentSince Aug 28, 2010 Accepting new patients
Sanford Health Network CurrentSince Aug 28, 2010 Accepting new patients
Sanford Health Network Internal Medicine Current Accepting new patients
Sanford Health Network Current Accepting new patients
Sanford Clinic Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients

Locations

249 5th St E
Tracy, MN 56175
Phone (507) 629-3520

830 8th St
Walnut Grove, MN 56180
Phone (507) 859-2157

920 Bell Ave
Westbrook, MN 56183
Phone (507) 274-1150

Interoperability endpoints

  • Direct secure messaging: akopperud1003818@direct.sanfordhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Samaritan Society - WestbrookWestbrook, MN, CCN 245595 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1629294533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 BELL AVE",
            "city": "WESTBROOK",
            "state": "MN",
            "postal_code": "561839669",
            "telephone_number": "507-274-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPERUD",
        "first_name": "ANDREW",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "57010337",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "53376",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "53376",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35089804",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akopperud1003818@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "920 Bell Ave",
            "city": "Westbrook",
            "state": "MN",
            "country_code": "US",
            "postal_code": "561839669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Westbrook, MN

Sources for this page

Verify at the official NPI Registry.