Dennis Shelly Koffer, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

9300504 Issued in NC

Practice address

131 E Market St
Smithfield, NC 27577-3915

Phone

(919) 934-5441

Fax

(919) 934-0152

NPI assigned

Jun 17, 2005

Sex

Male

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Johnston Health Services Corporation

  • Community Based Hospice Care Agency
  • Smithfield, NC
  • NPI 1033153606

  Corporate Director

  CMS ownership
• Johnston Health Services Corporation

  • Home Health Agency
  • Smithfield, NC
  • NPI 1902845928

  Corporate Director

  CMS ownership

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.

• Johnston Health Services Corporation

  • Community/Retail Pharmacy
  • Smithfield, NC
  • NPI 1588069181
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1982609707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 E MARKET ST",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773915",
            "telephone_number": "919-934-5441",
            "fax_number": "919-934-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 E MARKET ST",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275773915",
            "telephone_number": "919-934-5441",
            "fax_number": "919-934-0152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFER",
        "first_name": "DENNIS",
        "middle_name": "SHELLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "9300504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8942740",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkoffer99962@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "426 Hospital Rd",
            "city": "Smithfield",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275774104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jewal Velore Knight
• McKinley Bernard Knight, LMBT
• Ava Laurin Knowles
• Edyta Koczela, NP
• Kevin Bruce Koebley, D.D.S.
• Lindsey Koger, LMFTA
• Carly Kohler, MS, OTR/L
• Kelly Konczal, DDS
• Benjamin Koren, DDS
• Jessica Krieger

• Surgery Physician in Smithfield, NC
• Providers in Smithfield, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.