Individual provider Active NPI

Jason Andrew Hoover Cook, MD

  • General Practice Physician
  • Hugo, MN
National Provider Identifier
1174678932
Registry record updated Feb 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
036119192 Issued in IL
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, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
2429394MedicaidOH

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

LicenseStateTypeSpecialty
036119192ILMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Lights Pediatric & Adolescent Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: 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.

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

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.

Verify at the official NPI Registry.