Active NPI
Susan L Koeppe, C.N.P.
- Nurse Practitioner
- Morris, IL
National Provider Identifier
1871502369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209004405
- Practice address
- 1051 W US Route 6
Suite 100
Morris, IL 60450-3349 - Phone
- (815) 942-4875
- Fax
- (815) 942-5046
- NPI assigned
- Aug 5, 2006
- Last updated
- Jul 27, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209004405 | IL | Primary |
Addresses
Primary practice location
1051 W US Route 6
Suite 100
Morris, IL 60450-3349
Mailing address
1051 W US Route 6
Suite 100
Morris, IL 60450-3349
Phone (815) 942-4875
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0739010005 | Other | IL | MEDICARE NSC |
| 0739010006 | Other | IL | MEDICARE NSC |
| 0739010008 | Other | IL | MEDICARE NSC |
| CL7476 | Other | IL | RAILROAD MEDICARE GROUP # |
| P00294919 | Other | IL | RR MEDICARE |
| 0739010001 | Other | IL | MEDICARE NSC |
| 209004405 | Medicaid | IL |
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
- Certified Nurse Practitioner, Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248652800000",
"number": "1871502369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1051 W US ROUTE 6",
"address_2": "SUITE 100",
"city": "MORRIS",
"state": "IL",
"postal_code": "604503349",
"telephone_number": "815-942-4875",
"fax_number": "815-942-5046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 W US ROUTE 6",
"address_2": "SUITE 100",
"city": "MORRIS",
"state": "IL",
"postal_code": "604503349",
"telephone_number": "815-942-4875",
"fax_number": "815-942-5046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOEPPE",
"first_name": "SUSAN",
"middle_name": "L",
"credential": "C.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-05",
"last_updated": "2009-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209004405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NSC",
"identifier": "0739010005",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NSC",
"identifier": "0739010006",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NSC",
"identifier": "0739010008",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP #",
"identifier": "CL7476",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00294919",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NSC",
"identifier": "0739010001",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209004405",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morris, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.