Active NPI
Bruce W Kocourek, MD
- Family Medicine Physician
- Pipestone, MN
National Provider Identifier
1699738559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 34116
- Practice address
- 920 4TH Ave SW
Pipestone, MN 56164-1455 - Phone
- (507) 825-5700
- Fax
- (507) 825-4752
- NPI assigned
- Apr 10, 2006
- Last updated
- Oct 22, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34116 | MN | Primary |
Addresses
Primary practice location
920 4TH Ave SW
Pipestone, MN 56164-1455
Mailing address
916 4TH Ave SW
Pipestone, MN 56164-1890
Phone (507) 825-5700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 398003100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34116 | MN | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540166400000",
"number": "1699738559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "916 4TH AVE SW",
"city": "PIPESTONE",
"state": "MN",
"postal_code": "561641890",
"telephone_number": "507-825-5700",
"fax_number": "507-825-6239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 4TH AVE SW",
"city": "PIPESTONE",
"state": "MN",
"postal_code": "561641455",
"telephone_number": "507-825-5700",
"fax_number": "507-825-4752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCOUREK",
"first_name": "BRUCE",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2018-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "34116",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "398003100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pipestone, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.