Individual provider Active NPI

Isabella Marie Koutsopanagos

  • Physician Assistant
  • Madison, WI
National Provider Identifier
1891514030
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8893-23 Issued in WI
Practice address
752 N High Point Rd
Madison, WI 53717-2236
Phone
(608) 824-4000
Fax
(608) 294-6464
NPI assigned
Oct 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 8893-23 WI Primary

Addresses

Primary practice location

752 N High Point Rd
Madison, WI 53717-2236

Mailing address

2000 University Ave
Dubuque, IA 52001-5099
Phone (563) 589-3662

Other practice location 1

2000 University Ave
Dubuque, IA 52001-5099
Phone (563) 589-3662

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address ikoutsopanagod580111@direct-ehr-ssmhc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260608001350 WI Practitioner - Physician Assistant 8820569163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1808 W Beltline Hwy
Madison, WI 53713-2334

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1891514030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 UNIVERSITY AVE",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520015099",
            "telephone_number": "563-589-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "752 N HIGH POINT RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172236",
            "telephone_number": "608-824-4000",
            "fax_number": "608-294-6464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 University Ave",
            "address_purpose": "LOCATION",
            "city": "Dubuque",
            "state": "IA",
            "postal_code": "520015099",
            "country_code": "US",
            "telephone_number": "563-589-3662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUTSOPANAGOS",
        "first_name": "ISABELLA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-04",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8893-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ikoutsopanagod580111@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ikoutsopanagod580111@direct-ehr-ssmhc.com",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.