Active NPI
Jason Andrew Hoover Cook, MD
- General Practice Physician
- Hugo, MN
National Provider Identifier
1174678932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 036119192
- Practice address
- 14712 Victor Hugo Blvd.
Suite 4
Hugo, MN 55038-9458 - Phone
- (651) 777-2362
- Fax
- (651) 332-8554
- NPI assigned
- Jan 24, 2007
- Last updated
- Feb 21, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 036119192 | IL | Primary |
Addresses
Primary practice location
14712 Victor Hugo Blvd.
Suite 4
Hugo, MN 55038-9458
Mailing address
3555 Willow Lake Blvd.
Suite 140
Vadnais Heights, MN 55110-4462
Phone (651) 770-2124
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2429394 | 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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036119192 | IL | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Lights Pediatric & Adolescent Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EEEBCA/Endpoint/EEEBCA
Organizations & group practices 1
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.
-
- Pediatric Adolescent Medicine Physician
- Vadnais Heights, MN
- NPI 1912069519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392940800000",
"number": "1174678932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3555 WILLOW LAKE BLVD.",
"address_2": "SUITE 140",
"city": "VADNAIS HEIGHTS",
"state": "MN",
"postal_code": "551104462",
"telephone_number": "651-770-2124",
"fax_number": "651-251-5282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14712 VICTOR HUGO BLVD.",
"address_2": "SUITE 4",
"city": "HUGO",
"state": "MN",
"postal_code": "550389458",
"telephone_number": "651-777-2362",
"fax_number": "651-332-8554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "JASON",
"middle_name": "ANDREW HOOVER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2014-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "036119192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2429394",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Hugo, MN
- Children's Clinic Network (Children's Hugo Clinic)
- Chiropractic Health Solutions PLLC (HealthSource of Hugo)
- Jessica Ann Christensen, LICSW
- Brandyn S Christman, DC
- Emily Conery, MA, LPCC
- Maria Elizabeth Cook
- Cornerstone Chiropractic Specialists, P.a.
- Custom Woodcuts LLC
- Leticia Fernanda Da Silva
- Danielle Carlson Counseling, LLC (Equine Elevated)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.