Active NPI
Jamie Athela Cooper-Bracy
- Homemaker
- Van Buren, OH
National Provider Identifier
1164016879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- 3202635
- Practice address
- 13846 State Route 613
Van Buren, OH 45889-9715 - Phone
- (419) 889-5217
- NPI assigned
- Feb 23, 2021
- Last updated
- Feb 23, 2021
- 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 |
|---|---|---|---|---|
| Homemaker | 376J00000X | 3202635 | OH | Primary |
Addresses
Primary practice location
13846 State Route 613
Van Buren, OH 45889-9715
Mailing address
13846 State Route 613
Van Buren, OH 45889-9715
Phone (419) 889-5217
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3202635 | Medicaid | OH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3202635 | OH | MD | Homemaker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614038400000",
"number": "1164016879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13846 STATE ROUTE 613",
"city": "VAN BUREN",
"state": "OH",
"postal_code": "458899715",
"telephone_number": "419-889-5217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13846 STATE ROUTE 613",
"city": "VAN BUREN",
"state": "OH",
"postal_code": "458899715",
"telephone_number": "419-889-5217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER-BRACY",
"first_name": "JAMIE",
"middle_name": "ATHELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-23",
"last_updated": "2021-02-23",
"certification_date": "2021-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "OH",
"license": "3202635",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3202635",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Van Buren, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.