Individual provider Active NPI

Rachel Marie Koppenol, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1972191575
Registry record updated Mar 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
60720 Issued in CA
Practice address
1700 E Cesar E Chavez Ave Ste 2500
Los Angeles, CA 90033-2434
Phone
(323) 306-9632
Fax
(323) 268-6738
NPI assigned
Jan 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601010289 MI
Physician Assistant 363A00000X 60720 CA Primary

Addresses

Primary practice location

1700 E Cesar E Chavez Ave Ste 2500
Los Angeles, CA 90033-2434

Mailing address

1700 E Cesar E Chavez Ave Ste 2500
Los Angeles, CA 90033-2434
Phone (323) 306-9632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20220623000370 CA Practitioner - Physician Assistant 8628482015 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
60720CAMDGeneral Practice Dentistry
5601010289MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R. Gatto MD, Inc. PastSince Aug 1, 2007 Accepting new patients

Organizations & group practices 2

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": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1972191575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 2500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332434",
            "telephone_number": "323-306-9632",
            "fax_number": "323-268-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 2500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332434",
            "telephone_number": "323-306-9632",
            "fax_number": "323-268-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPENOL",
        "first_name": "RACHEL",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-08",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010289",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.