Diana E Koelliker, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

DR.0042229 Issued in CO

Practice address

500 W Pacific Ave
Telluride, CO 81435-1229

Phone

(970) 728-3848

Fax

(970) 728-3404

NPI assigned

Feb 15, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Emergency Medicine

Education

Medical College of Georgia School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Telluride Medical CenterGroup PAC ID 2961496807, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Telluride Medical Center

  • Emergency Care Clinic/Center
  • Telluride, CO
  • NPI 1508807694

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Vicksburg Healthcare LLC

  dba River Region Health System

  • Anesthesiology Physician
  • Vicksburg, MS
  • NPI 1629084058

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441152000000",
    "number": "1871567883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W PACIFIC AVE",
            "address_2": "PO BOX 1229",
            "city": "TELLURIDE",
            "state": "CO",
            "postal_code": "814351229",
            "telephone_number": "970-728-3848",
            "fax_number": "970-728-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W PACIFIC AVE",
            "city": "TELLURIDE",
            "state": "CO",
            "postal_code": "814351229",
            "telephone_number": "970-728-3848",
            "fax_number": "970-728-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELLIKER",
        "first_name": "DIANA",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2015-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0042229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59673222",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Hope Jakobsen, MSN, APRN, CRNA
• John David Jordan, DPT
• Lauren Patrice Kaas Norton
• Kindred Integrative Care LLC
• Laura Knight
• Robin Kondracki, SWC
• Jessika Laufenberg, L.AC.
• Jonathan M. Liaos
• Jaclin Limone
• Brooke Lockard, DPT

• Emergency Medicine Physician in Telluride, CO
• Providers in Telluride, CO by specialty
• Emergency Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; 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.