NPIMap

Individual provider Active NPI

Jahoon Koo, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Stanley, WI
National Provider Identifier
1629554209
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
APNP8026-33 Issued in WI
Practice address
1120 Pine St
Stanley, WI 54768-1297
Phone
(800) 643-0554
NPI assigned
Jul 17, 2018
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X APNP8026-33 WI Primary

Addresses

Primary practice location

1120 Pine St
Stanley, WI 54768-1297

Mailing address

12111 W Beloit Rd Apt 6
Greenfield, WI 53228-1910
Phone (262) 709-6597

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20201028000989 WI Practitioner - Nurse Practitioner 1355692922 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Stanley Hospital and Clinics IncGroup PAC ID 8325957095, shared by 6 NPIs, 34 clinicians
Aspirus Medford Hospital and Clinics IncGroup PAC ID 5799688602, shared by 9 NPIs, 126 clinicians

Practice addresses (Care Compare)

1120 Pine St
Stanley, WI 54768-1297
Phone (715) 644-5530

135 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

900 Illinois Ave
Stevens Point, WI 54481-3114
Phone (715) 346-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APNP8026-33WIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Stanley Hospital & Clinics, Inc. CurrentSince Oct 13, 2020 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc. CurrentSince Sep 1, 2022 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Mar 1, 2022 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Oct 1, 2025 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc CurrentSince Oct 13, 2020 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Oct 1, 2025 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince Mar 1, 2022 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

6 Johnson St
Owen, WI 54460
Phone (715) 229-2177

1120 Pine St
Stanley, WI 54768
Phone (715) 644-5530

209 Prentice St N
Stevens Point, WI 54481
Phone (715) 344-4611

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

704 S Clark St
Thorp, WI 54771
Phone (715) 669-5536

190 Grand Seasons Dr
Waupaca, WI 54981
Phone (715) 258-3401

Organizations & group practices 11

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 11

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": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1629554209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12111 W BELOIT RD APT 6",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532281910",
            "telephone_number": "262-709-6597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PINE ST",
            "city": "STANLEY",
            "state": "WI",
            "postal_code": "547681297",
            "telephone_number": "800-643-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOO",
        "first_name": "JAHOON",
        "credential": "ACNPC-AG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-17",
        "last_updated": "2022-12-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WI",
            "license": "APNP8026-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanley, WI

Sources for this page

Verify at the official NPI Registry.