ELLISE SUZANNE KOENN (NP) – Family Nurse Practitioner, NPI 1952897092
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ELLISE SUZANNE KOENN (NP)
16756 ROAD 87
CECIL, OH 458219630
Phone:
Type: Mailing
PO BOX 772437
DETROIT, MI 482772437
Phone: (317) 575-7304
Fax: (317) 575-7333
Type: Mailing
107 Buffalo Street
Antwerp, OH 45813
Phone: (419) 258-5641
Type: Location
107, Buffalo Street, Antwerp, Paulding County, Ohio, 45813, United States
ANTWERP, OH 45813
Phone: (419) 258-5641
Type: Location
10228 DUPONT CIRCLE DR E STE 100
FORT WAYNE, IN 468251611
Phone: (260) 222-7401
Fax: (260) 209-5956
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $328.
Total Amount is formed as General ($328) + Research ($0) + Ownership ($0) = $328.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Biogen, Inc. ($169).
Total Amount
$328
General + Research + Ownership
Payments
11
Total payment records
General Amount
$328
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Biogen, Inc. | $169 |
| Hologic Sales and Service, LLC | $159 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-08-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180822002780 | I | Nurse Practitioner | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 45821)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | OH | |
| - | OH | |
| General Surgery | IN | |
| - | OH | |
| - | OH |
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