Individual provider Active NPI

Mark Gregory Cooper, M.D.

  • Gastroenterology Physician
  • Grand Rapids, MI
National Provider Identifier
1164866430
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
Q6313 Issued in TX
Practice address
310 Lafayette Ave SE Ste 400
Grand Rapids, MI 49503-4693
Phone
(616) 752-6525
Fax
(616) 752-6556
NPI assigned
Apr 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X Q6313 TX Primary
Internal Medicine Physician 207R00000X Q6313 TX

Addresses

Primary practice location

310 Lafayette Ave SE Ste 400
Grand Rapids, MI 49503-4693

Mailing address

310 Lafayette Ave SE Ste 400
Grand Rapids, MI 49503-4693
Phone (616) 752-6525

Other practice location 1

1111 W 34th St Ste 200
Austin, TX 78705-1916
Phone (512) 454-4588

Other practice location 2

5323 Harry Hines Blvd
Dallas, TX 75390-7201
Phone (214) 645-0325

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926001039 MI Practitioner - Gastroenterology 1456641927 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Texas Medical School at Houston, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050

250 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5600

310 Lafayette Ave SE
Grand Rapids, MI 49503-4693

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy26
Upper gastrointestinal (GI) endoscopy for acid reflux48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q6313TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 19, 2024 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Grand River Gastroenterology PC Gastroenterology CurrentSince Sep 1, 2022 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 19, 2024 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

310 Lafayette Ave SE
Ste 40
Grand Rapids, MI 49503
Phone (616) 752-6525

310 Lafayette Ave SE
Ste 4
Grand Rapids, MI 49503
Phone (616) 752-6525

310 Lafayette Ave SE
Ste 400
Grand Rapids, MI 49503
Phone (616) 752-6525

Interoperability endpoints

  • Direct secure messaging: mcooper2118194@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1164866430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 LAFAYETTE AVE SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034693",
            "telephone_number": "616-752-6525",
            "fax_number": "616-752-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 LAFAYETTE AVE SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034693",
            "telephone_number": "616-752-6525",
            "fax_number": "616-752-6556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 W 34th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787051916",
            "country_code": "US",
            "telephone_number": "512-454-4588",
            "fax_number": "512-459-9869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907201",
            "country_code": "US",
            "telephone_number": "214-645-0325",
            "fax_number": "214-645-0078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MARK",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "Q6313",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q6313",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.