Kenneth Walter Koeritz Jr., MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

H0530 Issued in TX

Practice address

2501 Ambassador Dr
Waco, TX 76712-8944

Phone

(254) 752-4395

Fax

(254) 752-7343

NPI assigned

Oct 13, 2006

Last updated

Feb 16, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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 TX

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

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.

• Heart of Texas Community Health Center Inc

  dba Waco Family Medicine - Madison Cooper

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
  • NPI 1568191492
  Medicare reassignment NPD
• Heart of Texas Community Health Center, Inc

  dba Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
  • NPI 1164409926
  NPD
• Heart of Texas Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Temple, TX
  • NPI 1992685218
  NPD
• Ballew & Associates Podiatry, P.a.

  dba Waco Foot & Ankle, P.A.

  • Foot & Ankle Surgery Podiatrist
  • Waco, TX
  • NPI 1154396760
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266278400000",
    "number": "1881784775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 AMBASSADOR DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128944",
            "telephone_number": "254-752-4395",
            "fax_number": "254-752-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 AMBASSADOR DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767128944",
            "telephone_number": "254-752-4395",
            "fax_number": "254-752-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOERITZ",
        "first_name": "KENNETH",
        "middle_name": "WALTER",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2010-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "H0530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "097556702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Autumn Knowles
• Summer Knowles
• Jeron Knox
• Kate Ko, LPC
• Laura Kocurek
• Amy Elizabeth Koester, PA
• Donald Ray Koester, MD
• Paul Nicholas Koester
• Fodie B. Koita
• Aaron R Kolar, DO

• Obstetrics & Gynecology Physician in Waco, TX
• Providers in Waco, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.