Active NPI
Matthew P Koehler, MD
- Ophthalmology Physician
- Farmington Hills, MI
National Provider Identifier
1821093535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 4301102751
- Practice address
- 28501 Orchard Lake Rd
120
Farmington Hills, MI 48334-2951 - Phone
- (248) 553-9800
- Fax
- (248) 553-9808
- NPI assigned
- Jun 17, 2005
- Last updated
- Oct 2, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 049666 | OH | |
| Ophthalmology Physician | 207W00000X | 4301102751 | MI | Primary |
Addresses
Primary practice location
28501 Orchard Lake Rd
120
Farmington Hills, MI 48334-2951
Mailing address
7225 Old Oak Blvd
#B303
Middleburg Heights, OH 44130
Phone (440) 243-7400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0931159 | Other | MI | BCBSM |
| 1821093535 | Medicaid | MI | |
| 000000512381 | Other | OH | ANTHEM |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049666 | OH | MD | Ophthalmology Physician |
Interoperability endpoints
- mkoehler@yaldoeyecenter.direct.eyemdemr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380672000000",
"number": "1821093535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7225 OLD OAK BLVD",
"address_2": "#B303",
"city": "MIDDLEBURG HEIGHTS",
"state": "OH",
"postal_code": "44130",
"telephone_number": "440-243-7400",
"fax_number": "440-243-9034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28501 ORCHARD LAKE RD",
"address_2": "120",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483342951",
"telephone_number": "248-553-9800",
"fax_number": "248-553-9808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEHLER",
"first_name": "MATTHEW",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2013-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "OH",
"license": "049666",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MI",
"license": "4301102751",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "0931159",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1821093535",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000512381",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.