Individual provider Active NPI

Robert Mawunyo Koffie, MD

  • Neurological Surgery Physician
  • Gilbert, AZ
National Provider Identifier
1760744460
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
59734 Issued in AZ
Practice address
1757 E Baseline Rd Ste 131
Gilbert, AZ 85233-1534
Phone
(480) 999-5248
Fax
(480) 999-5285
NPI assigned
Jun 9, 2012
Last updated
Dec 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 71969-20 WI
Neurological Surgery Physician 207T00000X 59734 AZ Primary

Addresses

Primary practice location

1757 E Baseline Rd Ste 131
Gilbert, AZ 85233-1534

Mailing address

1757 E Baseline Rd Ste 131
Gilbert, AZ 85233-1534
Phone (480) 999-5248

Other practice location 1

2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone (920) 333-8878

Other identifiers 2

IdentifierTypeStateIssuer
100089494MedicaidWI
005313MedicaidAZ

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200430000889 WI Practitioner - Neurosurgery 2466689138 Reassigns benefits to 2 organizations
I20200509000060 AZ Practitioner - Neurosurgery 2466689138 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Harvard Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spine Capital LLCGroup PAC ID 6608240411, 2 clinicians
Spine Capital Wisconsin LLCGroup PAC ID 7315434230, 4 clinicians

Practice addresses (Care Compare)

1757 E Baseline Rd
Suite 131
Gilbert, AZ 85233-1534
Phone (480) 999-5248

2105 E Enterprise Ave
Appleton, WI 54913-7862
Phone (920) 333-8878

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion83
Laminectomy or laminotomy (partial removal of spine bones)11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71969-20WIMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spine Capital Wisconsin LLC Neurological Surgery CurrentSince Feb 1, 2025 Accepting new patients
District Medical Group, Inc CurrentSince Oct 1, 2020 Accepting new patients
District Medical Group, Inc CurrentSince Oct 1, 2020 Accepting new patients
Spine Capital, LLC Neurological Surgery CurrentSince Feb 8, 2023 Accepting new patients
District Medical Group, Inc Current Accepting new patients
The Neuroscience Group of Northeast Wisconsin SC Neurological Surgery CurrentSince Jun 18, 2020 Accepting new patients
Spine Capital LLC Neurological Surgery CurrentSince Jan 1, 2020 Accepting new patients

Locations

1757 E Baseline Rd
Ste 131
Gilbert, AZ 85233
Phone (480) 999-5248

2450 E Guadalupe Rd
Ste 103
Gilbert, AZ 85234
Phone (480) 907-6818

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
Ste 113
Appleton, WI 54913
Phone (920) 560-1083

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

1305 West American Dr
Neenah, WI 54956
Phone (920) 729-7687

Interoperability endpoints

  • Direct secure messaging: rkoffie221942@direct.valleywisehealth.org

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 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": "1339200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766448000000",
    "number": "1760744460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1757 E BASELINE RD STE 131",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852331534",
            "telephone_number": "480-999-5248",
            "fax_number": "480-999-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 E BASELINE RD STE 131",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852331534",
            "telephone_number": "480-999-5248",
            "fax_number": "480-999-5285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2105 E Enterprise Ave",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549137862",
            "country_code": "US",
            "telephone_number": "920-333-8878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOFFIE",
        "first_name": "ROBERT",
        "middle_name": "MAWUNYO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-09",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "71969-20",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AZ",
            "license": "59734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100089494",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005313",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

Verify at the official NPI Registry.