NPIMap

Individual provider Active NPI

Theresa Marie Koppie, MD

  • Urology Physician
  • Portland, OR
National Provider Identifier
1881794352
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A068661 Issued in CA
Practice address
3303 SW Bond Ave
Portland, OR 97239-4501
Phone
(503) 346-1500
Fax
(503) 346-1501
NPI assigned
Sep 25, 2006
Last updated
Aug 31, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A068661 CA Primary
Urology Physician 208800000X 2289321 NY
Urology Physician 208800000X 154558 OR

Addresses

Primary practice location

3303 SW Bond Ave
Portland, OR 97239-4501

Mailing address

3303 SW Bond Ave
Portland, OR 97239-4501
Phone (503) 346-1500

Other identifiers 2

IdentifierTypeStateIssuer
500634566MedicaidOR
1881794352MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110811000742 OR Practitioner - Urology 6608878749 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Southern California Keck School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centennial Medical Group IncGroup PAC ID 6103982962, 60 clinicians
Good Shepherd Health Care SystemGroup PAC ID 9133033764, 125 clinicians

Practice addresses (Care Compare)

2700 NW Stewart Pkwy
Roseburg, OR 97471-1281
Phone (541) 677-2452

610 NW 11TH St
Hermiston, OR 97838-6601
Phone (541) 667-3400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
24.01 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
80.03

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
64.68
Promoting interoperability
100
Improvement activities
40
Cost
47.05

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2289321NYMDSchool Psychologist
A068661CAMDUrology Physician
154558ORMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince May 1, 2025 Accepting new patients
Willamette Urology PC CurrentSince Jul 13, 2018 Accepting new patients
Providence Health & Services - Oregon CurrentSince May 1, 2025 Accepting new patients
Good Shepherd Health Care System CurrentSince Mar 13, 2024 Accepting new patients
Willamette Urology, PC Urology Current Accepting new patients
Centennial Medical Group Inc. Urology CurrentSince May 1, 2025 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince May 1, 2025 Accepting new patients
Providence Health & Services - Oregon CurrentSince May 1, 2025 Accepting new patients
Good Shepherd Health Care System Past Accepting new patients

Locations

600 NW 11th St
Ste E37
Hermiston, OR 97838
Phone (541) 567-5305

610 NW 11th St
Hermiston, OR 97838
Phone (541) 667-3400

620 NW 11th St
Ste M202
Hermiston, OR 97838
Phone (541) 667-3804

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

1698 E McAndrews Rd
Ste 200
Medford, OR 97504
Phone (541) 732-5537

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

201 NW Medical Loop
Ste 190
Roseburg, OR 97471
Phone (541) 644-4319

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

2973 12th St SE
Salem, OR 97302
Phone (503) 561-7100

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 11

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1881794352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-346-1500",
            "fax_number": "503-346-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-346-1500",
            "fax_number": "503-346-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPIE",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A068661",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "2289321",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "154558",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500634566",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881794352",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.