Active NPI
Carol Koskovich, RD
- Registered Dietitian
- Fairmont, MN
National Provider Identifier
1962487066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1662
- Practice address
- 800 Medical Center Dr
Fairmont, MN 56031-4575 - Phone
- (507) 238-8555
- NPI assigned
- Dec 12, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1662 | MN | Primary |
Addresses
Primary practice location
800 Medical Center Dr
Fairmont, MN 56031-4575
Mailing address
800 Medical Center Dr
PO Box 800
Fairmont, MN 56031-4575
Phone (507) 238-8555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 63-00305 | Other | MN | MEDICA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1662 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1962487066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"address_2": "PO BOX 800",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSKOVICH",
"first_name": "CAROL",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "1662",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "63-00305",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.