Samyukta Koppula, M.D.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

00303660782441 Issued in IL

Practice address

6857 Kingery Hwy
Willowbrook, IL 60527-5114

Phone

(630) 323-8800

Fax

(630) 850-9797

NPI assigned

Dec 4, 2006

Last updated

Sep 30, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Allergy/ImmunologyAlso: Internal Medicine

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Prana Center for Asthma and Allergy LLC

  • Allergy & Immunology Physician
  • Willowbrook, IL
  • NPI 1821211491
  Medicare reassignment NPD Authorized official
• Diane L Ozog, MDSC

  • Allergy & Immunology Physician
  • Naperville, IL
  • NPI 1245374875
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1770641763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6857 KINGERY HWY",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275114",
            "telephone_number": "630-323-8800",
            "fax_number": "630-850-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6857 KINGERY HWY",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275114",
            "telephone_number": "630-323-8800",
            "fax_number": "630-850-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPULA",
        "first_name": "SAMYUKTA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "IL",
            "license": "00303660782441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF IL LICENCE",
            "identifier": "003-036-078244-1",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "2233164",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Kim
• Hilda Kina, APRN
• Katlynn Klinetobe, FNP
• Anna Kolencherry, D.M.D
• Alyssa Kondratiuk, DNP
• Stephanie A Korby, PHARMD
• Leslie Ann Korotka, D.P.T.
• Anna Maria Koziel, APRN, FNP-C
• Monika Sylvia Kozuch
• KPR Endocrinology LLC

• Allergy & Immunology Physician in Willowbrook, IL
• Providers in Willowbrook, IL by specialty
• Allergy & Immunology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.