Individual provider Active NPI

Charles A Cooley, D.D.S.

Dentist
Tyler, TX

National Provider Identifier

1093920761

Registry record updated Jun 23, 2009

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Tyler, TX
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: DentistTaxonomy code 122300000X
License: 20146 Issued in TX
Practice address: 601 Turtle Creek Dr
Tyler, TX 75701-1832
Phone: (903) 592-6535
NPI assigned: May 14, 2007
Sex: Male
Sole proprietor: Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

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
Dentist	122300000X	20146	TX	Primary

Addresses

Primary practice location

601 Turtle Creek Dr
Tyler, TX 75701-1832

Mailing address

601 Turtle Creek Dr
Tyler, TX 75701-1832
Phone (903) 592-6535

Other identifiers 46

Identifier	Type	State	Issuer
201047746	Other	NY	DELTA DENTAL
201047746	Other	KY	AETNA
201047746	Other	CA	BC LIFE & HEALTH DENTAL SERVICES
201047746	Other	NC	COVENTRY HEALTH CARE
201047746	Other	NE	AMERITAS LIFE
201047746	Other	MA	SUN LIFE AND HEALTH INS.
201047746	Other	UT	UNITED HEALTHCARE DENTAL
201047746	Other	MO	GEHA STATE OF TX DENTAL CHOICE
201047746	Other	PA	UNITED CONCORDIA
201047746	Other	KY	HUMANA
201047746	Other	CA	LIBERTY DENTAL
201047746	Other	IA	ASSURANT
201047746	Other	MI	DELTA DENTAL OF MI, OH, IN
201047746	Other	OK	BLUE CROSS BLUE SHIELD OF OKLAHOMA
201047746	Other	TN	BLUE CROSS BLUE SHIELD OF TENNESSEE
201047746	Other	CA	DELTA DENTAL OF CALIFORNIA
20104776	Other	NC	PRIMARY CARE PHYSICIANS
20104776	Other	IL	DENTAL NETWORK OF AMERICA
201047746	Other	TX	METLIFE DENTAL
201047746	Other	TX	FISERVHEALTH
201047746	Other		CIGNA
201047746	Other	CA	UNICARE
201047746	Other	TX	UMR
201047746	Other	IA	DELTA DENTAL OF IOWA
201047746	Other	AR	DELTA DENTAL OF ARKANSAS
201047746	Other	AL	BLUE CROSS BLUE SHIELD OF ALABAMA
201047746	Other	MN	DELTA DENTAL
201047746	Other	OK	OLD SURRETY LIFE
201047746	Other	TN	DELTA DENTAL OF TENNESSEE
201047746	Other	WA	STERLING LIFE INS. CO.
201047746	Other	KS	DELTA DENTAL
201047746	Other	TX	BLUE CROSS BLUE SHIELD FEDERAL
201047746	Other	IL	LINECO
201047746	Other	KY	DELTA DENTAL OF KENTUCKY
20104776	Other	TX	HEALTHFIRST TPA
20104776	Other	VA	GENWORTH FINANCIAL
201047746	Other	GA	DELTA DENTAL OF GEORGIA
201047746	Other	IA	PRINCIPAL LIFE
201047746	Other	FL	COMPBENEFITS
201047746	Other	IL	BLUE CROSS BLUE SHIELD OF ILLINOIS
20104776	Other	TX	WEB TPA
201047746	Other	NJ	DELTA DENTAL
201047746	Other	WA	GUARDIAN
201047746	Other		CENTRAL STATES SOUTHEAST AND SOUTHWEST
201047746	Other	CA	SAFEHEALTH LIFE INS.
88D834	Other	TX	BLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

Part B services: Yes
Medical equipment: Yes
Home health: Yes
Power mobility devices: No
Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
I20161010000246	TX	Order and Referring Only - DentistPractitioner - Dentist	2961790852

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
20146	TX	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Cooley Cosmetic & Family Dentistry, P.C.		Past	Accepting new patients

Organizations & group practices 1

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.

Cooley Cosmetic & Family Dentistry, P.C.
- General Practice Dentistry
- Tyler, TX
- NPI 1184996316
NPD (past) Authorized official

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245715200000",
    "number": "1093920761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011832",
            "telephone_number": "903-592-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011832",
            "telephone_number": "903-592-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2009-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "20146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "201047746",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "201047746",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC LIFE & HEALTH DENTAL SERVICES",
            "identifier": "201047746",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTH CARE",
            "identifier": "201047746",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERITAS LIFE",
            "identifier": "201047746",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUN LIFE AND HEALTH INS.",
            "identifier": "201047746",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE DENTAL",
            "identifier": "201047746",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEHA STATE OF TX DENTAL CHOICE",
            "identifier": "201047746",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "201047746",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "201047746",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIBERTY DENTAL",
            "identifier": "201047746",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSURANT",
            "identifier": "201047746",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF MI, OH, IN",
            "identifier": "201047746",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF OKLAHOMA",
            "identifier": "201047746",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TENNESSEE",
            "identifier": "201047746",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF CALIFORNIA",
            "identifier": "201047746",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIMARY CARE PHYSICIANS",
            "identifier": "20104776",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL NETWORK OF AMERICA",
            "identifier": "20104776",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METLIFE DENTAL",
            "identifier": "201047746",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FISERVHEALTH",
            "identifier": "201047746",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "201047746",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "201047746",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMR",
            "identifier": "201047746",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF IOWA",
            "identifier": "201047746",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF ARKANSAS",
            "identifier": "201047746",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ALABAMA",
            "identifier": "201047746",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "201047746",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD SURRETY LIFE",
            "identifier": "201047746",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF TENNESSEE",
            "identifier": "201047746",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STERLING LIFE INS. CO.",
            "identifier": "201047746",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "201047746",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD FEDERAL",
            "identifier": "201047746",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LINECO",
            "identifier": "201047746",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF KENTUCKY",
            "identifier": "201047746",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHFIRST TPA",
            "identifier": "20104776",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENWORTH FINANCIAL",
            "identifier": "20104776",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF GEORGIA",
            "identifier": "201047746",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRINCIPAL LIFE",
            "identifier": "201047746",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPBENEFITS",
            "identifier": "201047746",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "201047746",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WEB TPA",
            "identifier": "20104776",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "201047746",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GUARDIAN",
            "identifier": "201047746",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTRAL STATES SOUTHEAST AND SOUTHWEST",
            "identifier": "201047746",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAFEHEALTH LIFE INS.",
            "identifier": "201047746",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "88D834",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.