Active NPI
Joseph P Coppola, DO
- Family Medicine Physician
- Bradenton, FL
National Provider Identifier
1013969583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS7713
- Practice address
- 5108 Tidewater Preserve Blvd
Bradenton, FL 34208-5706 - Phone
- (413) 658-7138
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS7713 | FL | |
| Family Medicine Physician | 207Q00000X | OS7713 | FL | Primary |
Addresses
Primary practice location
5108 Tidewater Preserve Blvd
Bradenton, FL 34208-5706
Mailing address
5108 Tidewater Preserve Blvd
Bradenton, FL 34208-5706
Phone (413) 658-7138
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009068100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130920000599 | FL | Practitioner - Internal Medicine | 6002702321 | Reassigns benefits to 1 organization |
| I20250730002979 | WY | Practitioner - Internal Medicine | 6002702321 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital of Converse County
Practice addresses (Care Compare)
6500 E 2ND St
Casper, WY 82609-4338
Phone (307) 577-5100
700 E Ctr St
Douglas, WY 82633-2446
Phone (307) 358-7300
Hospital & facility affiliations
- Home and Care
- Casper Home Health LLC
- Memorial Hospital of Converse County
- Banner Wyoming Medical Center
- Sheridan Memorial Hospital
- Big Horn Rehabilitation and Care Center
- Life Care Center of Casper
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.04 of 100
- Quality
- 80.07
- Promoting interoperability
- 100
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS7713 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Memorial Medical Group LLC | Current | Accepting new patients | |
| Frye Emergency Medical Associates LLC | Past | Accepting new patients | |
| North Big Horn Hospital District | Past | Accepting new patients | |
| Baystate Affiliated Practice Organization | Family Medicine | Past | Accepting new patients |
Locations
6500 E 2nd St
Casper, WY 82609
Phone (307) 235-4180
111 S 5th St
Douglas, WY 82633
Phone (307) 358-6200
222 S 5th St
Douglas, WY 82633
Phone (307) 286-6738
700 E Center St
Douglas, WY 82633
Phone (307) 352-8946
1851 Big Horn Ave
Sheridan, WY 82801
Phone (307) 674-4416
1356 Shiek St
Wheatland, WY 82201
Phone (307) 322-3861
Organizations & group practices 7
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.
-
- Internal Medicine Physician
- Springfield, MA
- NPI 1043256043
Family Medicine
-
- Emergency Medicine Physician
- Hickory, NC
- NPI 1194781369
-
- Skilled Nursing Facility
- Sheridan, WY
- NPI 1669290854
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Casper, WY
- NPI 1336652452
-
- Home Health Agency
- Casper, WY
- NPI 1437508975
-
- General Acute Care Hospital
- Sheridan, WY
- NPI 1487707188
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1013969583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5108 TIDEWATER PRESERVE BLVD",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342085706",
"telephone_number": "413-658-7138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5108 TIDEWATER PRESERVE BLVD",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342085706",
"telephone_number": "413-658-7138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "JOSEPH",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "OS7713",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS7713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009068100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bradenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.