Laurel Katherine Hallock Koppelman, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201392556 Issued in OR

Practice address

12720 SE Division Street
Portland, OR 97236

Phone

(503) 988-3601

NPI assigned

Jan 30, 2014

Last updated

Apr 23, 2014By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Nurse Practitioner

Education

Oregon Health Sciences University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

99.11 of 100Reported as apm

Quality

84.29

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lhallockkeppelmannp76808@direct.ohsu.edu

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.

• University Professional Services

  • General Practice Physician
  • Portland, OR
  • NPI 1376709535
  Medicare reassignment Care Compare group NPD
• Multnomah County

  dba Multnomah County Health Dept, North Portland

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1609914787
  Medicare reassignment NPD
• Oregon Health & Science University

  dba OHSU Scappoose Rural Health Clinic

  • Rural Health Clinic/Center
  • Scappoose, OR
  • NPI 1417969304
  Medicare reassignment NPD
• Mulnomah County

  dba Multnomah County Health Department FQHC

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1649339581
  NPD
• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Gresham, OR
  • NPI 1912322074
  NPD
• Oregon Health & Science University

  dba Ohsu East Portland Pharmacy

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1457129678
  NPD
• Oregon Health & Science University

  dba OHSU Family Medicine at Richmond Walk-In Clinic

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1487902706
  NPD
• University Professional Services

  dba OHSU Home Infusion Pharmacy

  • Pharmacy
  • Beaverton, OR
  • NPI 1073054714
  NPD
• University Professional Services

  dba OHSU Avel Gordly Center for Healing

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1316354970
  NPD

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398211200000",
    "number": "1942623764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 SW OAK ST",
            "address_2": "STE. 210",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972041817",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 SE DIVISION STREET",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97236",
            "telephone_number": "503-988-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLOCK KOPPELMAN",
        "first_name": "LAUREL",
        "middle_name": "KATHERINE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201392556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Hallin
• Jessica Hallinan, L.M.T.
• Julia Jane Hallis
• Jennifer Ann Hallman, LCSW
• Hallmark Opticians
• Mark Anthony Halloran Jr., PSS CRM QMHAR CADCR
• Li Lin Hally, LCSW
• Margo A Halm, PHD, RN, NEA-BC, FAA
• Loren Halman, MA
• Patrick Michael Halmer, PHARMD

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; 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.