Individual provider Active NPI

Herman Adriaan Koster, PT

  • Physical Therapist
  • El Paso, TX
National Provider Identifier
1831135318
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1054971 Issued in TX
Practice address
6358 Edgemere Blvd
El Paso, TX 79925-3517
Phone
(915) 562-8525
Fax
(915) 566-3889
NPI assigned
Jun 21, 2006
Last updated
Nov 18, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1054971 TX Primary

Addresses

Primary practice location

6358 Edgemere Blvd
El Paso, TX 79925-3517

Mailing address

6724 Desert Canyon Dr
El Paso, TX 79912-7604
Phone (915) 845-3152

Other identifiers 1

IdentifierTypeStateIssuer
108032703MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090522000205 TX Practitioner - Physical Therapist in Private Practice 3870574965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physiotherapy of El Paso, P.C.Group PAC ID 9638150725, 9 clinicians

Practice addresses (Care Compare)

11855 Physicians Dr
El Paso, TX 79936-6280
Phone (915) 855-6466

6358 Edgemere
El Paso, TX 79925-3517

6358 Edgemere Blvd
El Paso, TX 79925-3517
Phone (915) 562-8525

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1444NMMDPeer Specialist
1054971TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physiotherapy of El Paso, P.C. Physical Therapist CurrentSince Dec 31, 2000 Accepting new patients
Southwest Sport and Spine Center Inc Physical Therapist PastSince Apr 7, 2000 Accepting new patients
Real View Diagnostics LLC Physical Therapist Past Accepting new patients

Locations

11855 Physicians Dr
El Paso, TX 79936
Phone (915) 562-8525

2900 Pershing Dr
Ste B
El Paso, TX 79903
Phone (915) 562-8525

6358 Edgemere Blvd
El Paso, TX 79925
Phone (915) 562-8525

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1831135318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6724 DESERT CANYON DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799127604",
            "telephone_number": "915-845-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6358 EDGEMERE BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799253517",
            "telephone_number": "915-562-8525",
            "fax_number": "915-566-3889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTER",
        "first_name": "HERMAN",
        "middle_name": "ADRIAAN",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1054971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108032703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.