Ellise Suzanne Koenn, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71012516A Issued in IN

Practice address

10228 Dupont Circle Dr E Ste 100
Fort Wayne, IN 46825-1611

Phone

(260) 222-7401

Fax

(260) 209-5956

NPI assigned

Jul 2, 2018

Last updated

Feb 1, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ellise.koenn.1@21210.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/21210/brand/1/csg/1/fhir/r4

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.

• Fertility and Midwifery Care Center LLC

  • Obstetrics & Gynecology Physician
  • Fort Wayne, IN
  • NPI 1376955070
  NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1952897092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772437",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482772437",
            "telephone_number": "317-575-7304",
            "fax_number": "317-575-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10228 DUPONT CIRCLE DR E STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251611",
            "telephone_number": "260-222-7401",
            "fax_number": "260-209-5956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Buffalo Street",
            "address_purpose": "LOCATION",
            "city": "Antwerp",
            "state": "OH",
            "postal_code": "45813",
            "country_code": "US",
            "telephone_number": "419-258-5641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOENN",
        "first_name": "ELLISE",
        "middle_name": "SUZANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71012516A",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "APRN.CNP.023023",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Koehneke
• Jessica Elaine Koehneke, CTRS
• Hannah Koeneman I
• Alex Michael Koenemann, NP
• Beth Ann Koenemann, LCSW
• Benjamin Joel Koerner
• Thomas E Koerner, MD
• Tamera A Koesters, PT
• Anna Koeva, RPH
• Lauren May Koffman, DO

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; 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.