Active NPI
Jessica Alexis Koller, ATC
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Columbia, SC
National Provider Identifier
1992042360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 1339
- Practice address
- 2 Medical Park Rd
Columbia, SC 29203-6808 - Phone
- (203) 470-1558
- NPI assigned
- Jan 5, 2013
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 1339 | SC | Primary |
Addresses
Primary practice location
2 Medical Park Rd
Columbia, SC 29203-6808
Mailing address
215 Spencer PL
Apt 913
Cayce, SC 29033-3980
Phone (203) 470-1558
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1339 | SC | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357344000000",
"number": "1992042360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 SPENCER PL",
"address_2": "APT 913",
"city": "CAYCE",
"state": "SC",
"postal_code": "290333980",
"telephone_number": "203-470-1558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 MEDICAL PARK RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036808",
"telephone_number": "203-470-1558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLLER",
"first_name": "JESSICA",
"middle_name": "ALEXIS",
"name_prefix": "Miss",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-05",
"last_updated": "2013-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "SC",
"license": "1339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.