Xander Jack Cooper

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

130974

Practice address

1202 Morena Blvd Ste 300
San Diego, CA 92110-3844

Phone

(619) 276-8112

NPI assigned

Jul 18, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Marriage and Family Therapist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kab Medical Group IncGroup PAC ID 7719211358, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Kab Medical Group Inc

  • Psychiatry Physician
  • Chula Vista, CA
  • NPI 1639634421
  Medicare reassignment Care Compare group NPD
• YMCA of San Diego County

  • Community/Behavioral Health Agency
  • San Diego, CA
  • NPI 1306979406
  NPD (past)

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1114403573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MORENA BLVD STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103844",
            "telephone_number": "619-276-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MORENA BLVD STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103844",
            "telephone_number": "619-276-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "XANDER",
        "middle_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-18",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": "130974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roxanna Elena Cooper, M.S.
• Shani Ayanna Cooper, L.AC.
• Sheridan Augustine Marshall Cooper
• Steve Oland Cooper Jr.
• Tiffany Joyce Cooper, MS, RD
• Rebecka Lynn Cooperman, NP
• Chene Coordt, OTR/L
• Coounty of San Diego
• Patrick Cope
• Angela Copeland, PSYD

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.

Verify at the official NPI Registry.