Individual provider Active NPI

Robert James Cooley, PHD

  • Psychologist
  • Toledo, OH
National Provider Identifier
1033205349
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5123 Issued in OH
Practice address
930 S Detroit Ave
Toledo, OH 43614-2701
Phone
(419) 381-1881
NPI assigned
Oct 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5123 OH Primary

Addresses

Primary practice location

930 S Detroit Ave
Toledo, OH 43614-2701

Mailing address

30 E Broad St
11TH FL. Attn: Tonya Fasone
Columbus, OH 43215-3414
Phone (614) 466-9930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111221000658 OH Practitioner - Clinical Psychologist 9739355744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

930 S Detroit Ave
Toledo, OH 43614-2701
Phone (419) 381-1881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
5123OHMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Ohio Office of Budget and Management State Accounting Current Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince May 31, 2002 Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince May 31, 2002 Accepting new patients
Harbor Past Accepting new patients

Locations

30 E Broad St
Fl 11
Columbus, OH 43215
Phone (614) 466-9930

930 S Detroit Ave
Toledo, OH 43614
Phone (419) 381-1881

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033205349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E BROAD ST",
            "address_2": "11TH FL. ATTN: TONYA FASONE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153414",
            "telephone_number": "614-466-9930",
            "fax_number": "614-644-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S DETROIT AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436142701",
            "telephone_number": "419-381-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "5123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.