Kordell Alan Koepnick, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2450 Issued in ID

Practice address

500 S 8TH St
Boise, ID 83702-7107

Phone

(855) 255-1750

Fax

(855) 255-0905

NPI assigned

Feb 2, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 9

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID, WA, OR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

United Wound Healing PSGroup PAC ID 2860794070, 32 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.56 of 100Reported as group

Quality

71.73

Improvement activities

40

Cost

80.37

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• United Wound Healing PS

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Puyallup, WA
  • NPI 1669845327

  ID, OR

  Medicare reassignment Care Compare group
• United Wound Healing Accountable Care Consultants PLLC

  • Surgery Physician
  • Puyallup, WA
  • NPI 1881337632

  Physician Assistant

  NPD

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

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1770289621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11504 PAINTBRUSH LN",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832025077",
            "telephone_number": "208-312-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S 8TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027107",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Meadows Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970350086",
            "country_code": "US",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "413 29th St NE Ste I",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983727154",
            "country_code": "US",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEPNICK",
        "first_name": "KORDELL",
        "middle_name": "ALAN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-02",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-2450",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61460460",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA219548",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA61460460",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA219548",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ID",
            "license": "PA-2450",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA219548",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2450",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA6140460",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2261987",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770289621",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500841624",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon Michael Koeltl, D.D.S.
• Carl T Koenen, MD
• Krista Koenig
• Steve Craig Koenig, RPH
• David Alan Koeplin, MD
• Jay Koernke, MD
• Corenne Koerwitz, NP
• Lavar W Kofoed, O.D.
• Alison Kogei
• William Kogler, DO

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.