Connie Dale Cook II, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

626 Issued in WV

Practice address

600 E McDonald Ave
Man, WV 25635-1097

Phone

(304) 583-6541

Fax

(304) 583-6018

NPI assigned

Jun 8, 2005

Last updated

Feb 11, 2010By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Family Healthcare Associates Inc

  • Rural Health Clinic/Center
  • Mullens, WV
  • NPI 1700815800
  Medicare reassignment NPD
• Family Healthcare Associates Inc

  • Family Medicine Physician
  • Welch, WV
  • NPI 1134565450
  NPD
• Family Healthcare Associates Inc

  • Rural Health Clinic/Center
  • Oceana, WV
  • NPI 1275562373
  NPD
• Family Healthcare Associates Inc

  • Rural Health Clinic/Center
  • Gilbert, WV
  • NPI 1376572479
  NPD
• Family Healthcare Associates Inc

  • Rural Health Clinic/Center
  • Man, WV
  • NPI 1902835010
  NPD
• Family Healthcare Associates, Inc

  • Rural Health Clinic/Center
  • Welch, WV
  • NPI 1215365028
  NPD

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265846400000",
    "number": "1164426128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 MAIN STREET",
            "city": "PINEVILLE",
            "state": "WV",
            "postal_code": "248741650",
            "telephone_number": "304-732-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E MCDONALD AVE",
            "city": "MAN",
            "state": "WV",
            "postal_code": "256351097",
            "telephone_number": "304-583-6541",
            "fax_number": "304-583-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "CONNIE",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2010-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000560",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Community Health Foundation
• Community Health Foundation
• Community Health Foundation of Man WV
• Community Prescription Center Inc (Man Pharmacy)
• Community Prescription Center Inc (Man Pharmacy)
• Haley Crum, FNP-BC
• Terri D Doss, RPH
• Taylor Duncan, PHARMD
• Jonathan Matthew Ellis, B.S., D.C.
• Wilson Gene Evans

• Medical Physician Assistant in Man, WV
• Providers in Man, WV by specialty
• Medical Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; 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.