NPIMap

Individual provider Active NPI

Emily Koeck, MD

  • Surgery Physician
  • Saint Paul, MN
National Provider Identifier
1891006961
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036143464 Issued in IL
Practice address
640 Jackson St # Ms 11502V
Saint Paul, MN 55101
Phone
(651) 254-7990
Fax
(651) 254-7990
NPI assigned
Jun 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036143464 IL Primary

Addresses

Primary practice location

640 Jackson St # Ms 11502V
Saint Paul, MN 55101

Mailing address

8170 33Rd Ave S Ms 21110Q
Minneapolis, MN 55485-1450
Phone (651) 254-7980

Other practice location 1

110 Francis St
Suite 9B
Boston, MA 02215-5501
Phone (617) 632-9581

Other practice location 2

110 Francis St
Suite 9B
Boston, MA 02215-5501
Phone (617) 632-9581

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20190912002128 MN Practitioner - General Surgery 1153689971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Dakota School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

Hospital & facility affiliations

  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106
  • Lakeview Memorial Hospital Hospital, Stillwater, MN, CCN 240066

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health Plan, Inc. CurrentSince Oct 1, 2019 Accepting new patients
Group Health, Inc. CurrentSince Oct 1, 2019 Accepting new patients
Group Health, Inc. Current Accepting new patients
Regions Hospital Past Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

640 Jackson St
#11502V
Saint Paul, MN 55101
Phone (651) 254-7980

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567123200000",
    "number": "1891006961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554851450",
            "telephone_number": "651-254-7980",
            "fax_number": "952-853-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST # MS 11502V",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55101",
            "telephone_number": "651-254-7990",
            "fax_number": "651-254-7990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Francis St",
            "address_2": "Suite 9B",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155501",
            "country_code": "US",
            "telephone_number": "617-632-9581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 Francis St",
            "address_2": "Suite 9B",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155501",
            "country_code": "US",
            "telephone_number": "617-632-9581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOECK",
        "first_name": "EMILY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2019-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036143464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.