Active NPI
Carol Ann Cooper, DC
- Internist Chiropractor
- Keizer, OR
National Provider Identifier
1104975721
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(14) exclusion effective Dec 20, 2018.
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- 2510
- Practice address
- 4131 River Rd N
Keizer, OR 97303-5559 - Phone
- (503) 393-6071
- Fax
- (503) 390-5200
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
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 |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | 2510 | OR | Primary |
Addresses
Primary practice location
4131 River Rd N
Keizer, OR 97303-5559
Mailing address
4131 River Rd N
Keizer, OR 97303-5559
Phone (503) 393-6071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2510 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1104975721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4131 RIVER RD N",
"city": "KEIZER",
"state": "OR",
"postal_code": "973035559",
"telephone_number": "503-393-6071",
"fax_number": "503-390-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4131 RIVER RD N",
"city": "KEIZER",
"state": "OR",
"postal_code": "973035559",
"telephone_number": "503-393-6071",
"fax_number": "503-390-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "CAROL",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "OR",
"license": "2510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keizer, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.