NPIMap

Individual provider Active NPI

John Cooper Gollier, MD

  • Family Medicine Physician
  • Ottawa, KS
National Provider Identifier
1104857911
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-28601 Issued in KS
Practice address
1418 S Main St
Suite 5
Ottawa, KS 66067-3543
Phone
(785) 242-1620
Fax
(785) 242-3825
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-28601 KS Primary

Addresses

Primary practice location

1418 S Main St
Suite 5
Ottawa, KS 66067-3543

Mailing address

1418 S Main St
Suite 5
Ottawa, KS 66067-3543
Phone (785) 242-1620

Other identifiers 5

IdentifierTypeStateIssuer
2924584001OtherKSCIGNA INDIVIDUAL NUMBER
5818702OtherKSAETNA INDIVIDUAL NUMBER
335891OtherKSHEALTHWAVE
058541OtherKSBLUE CROSS BLUE SHIELD KS
26325027OtherKSBC/BS KANSAS CITY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050609000863 KS Practitioner - Family Practice 4981647914 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 1997
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

1418 S Main St
Suite 5
Ottawa, KS 66067-3543

1418 S Main St
Suite 5
Ottawa, KS 66067-3544

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.71 of 100Reported as group
Quality
80.22
Improvement activities
40
Cost
58.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-28601KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ottawa Family Physicians, Chartered Family Medicine CurrentSince Aug 1, 2000 Accepting new patients
Ottawa Family Physicians, Chartered Family Medicine CurrentSince Aug 1, 2000 Accepting new patients

Locations

1418 S Main St
Ste 5
Ottawa, KS 66067
Phone (785) 242-1620

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ottawa Family Physicians, CharteredOttawa, KS, CCN 173876 Rural health clinic 5% Or Greater Direct Ownership Interest
General Partnership Interest		 Sep 24, 2010
Jul 1, 2002

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104857911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673543",
            "telephone_number": "785-242-1620",
            "fax_number": "785-242-3825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 S MAIN ST",
            "address_2": "SUITE 5",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673543",
            "telephone_number": "785-242-1620",
            "fax_number": "785-242-3825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLIER",
        "first_name": "JOHN",
        "middle_name": "COOPER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-28601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA INDIVIDUAL NUMBER",
            "identifier": "2924584001",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INDIVIDUAL NUMBER",
            "identifier": "5818702",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHWAVE",
            "identifier": "335891",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD KS",
            "identifier": "058541",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS KANSAS CITY",
            "identifier": "26325027",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, KS

Sources for this page

Verify at the official NPI Registry.