NPIMap

Individual provider Active NPI

Ian Coker, DO

  • Family Medicine Physician
  • Edgewood, KY
National Provider Identifier
1699390633
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
81229-21 Issued in WI
Practice address
413 S Loop Rd
Edgewood, KY 41017-5446
Phone
(859) 301-3800
Fax
(859) 301-3987
NPI assigned
Jun 16, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 81229-21 WI Primary

Addresses

Primary practice location

413 S Loop Rd
Edgewood, KY 41017-5446

Mailing address

413 S Loop Rd
Edgewood, KY 41017-5446
Phone (859) 301-3800

Other practice location 1

2817 New Pinery Rd
Portage, WI 53901-9240
Phone (608) 742-4131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230720004019 WI Practitioner - Family Practice 1254791346
I20250721003105 AZ Practitioner - Family Practice 1254791346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner-University Medical GroupGroup PAC ID 7719899871, 1,066 clinicians

Practice addresses (Care Compare)

2800 E Ajo Way
Tucson, AZ 85713-6204
Phone (520) 874-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.7 of 100Reported as group
Quality
91.14
Promoting interoperability
100
Improvement activities
40
Cost
77.5

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
81229-21WIMDFamily Medicine Physician
81229WIMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner-University Medical Group Family Medicine Current Accepting new patients
Banner-University Medical Group CurrentSince Sep 1, 2025 Accepting new patients
Aspirus Riverview Hospital & Clinics, Inc. Current Accepting new patients
Banner-University Medical Group CurrentSince Sep 1, 2025 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Banner - University Medical Center South Campus LLC Past Accepting new patients

Locations

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

1625 N Campbell Ave
Tucson, AZ 85719

29980 Network Pl
Chicago, IL 60673

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

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

420 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-7474

410 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-5257

Organizations & group practices 6

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 2

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": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1699390633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175446",
            "telephone_number": "859-301-3800",
            "fax_number": "859-301-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175446",
            "telephone_number": "859-301-3800",
            "fax_number": "859-301-3987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2817 New Pinery Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "WI",
            "postal_code": "539019240",
            "country_code": "US",
            "telephone_number": "608-742-4131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COKER",
        "first_name": "IAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-16",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81229-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.