Jack T. Cook, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

432 Issued in NH

Practice address

250 Pleasant Street
Yeaple Building
Concord, NH 03301-7539

Phone

(603) 228-7200

Fax

(603) 228-7307

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

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.

• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2013.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372032000000",
    "number": "1194720052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PLEASANT STREET",
            "address_2": "YEAPLE BUILDING",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033017539",
            "telephone_number": "603-228-7200",
            "fax_number": "603-228-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PLEASANT STREET",
            "address_2": "YEAPLE BUILDING",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033017539",
            "telephone_number": "603-228-7200",
            "fax_number": "603-228-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JACK",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2013-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREATWEST HEALTHCARE",
            "identifier": "222594672",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "222594672",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30334856",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTHCARE",
            "identifier": "378781",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Convenientmd LLC
• David C. Conway, M.D.
• Bonnie Cook
• Brigitte L Cook, PT
• Christopher Patrick Cook, PT, MS
• Erin Coolidge
• Emily Cooper, MSW
• Jill Emily Cooper, MSW
• Coppola Physical Therapy Ferry
• John Coppola, M.A.

• All providers in Concord, NH
• Medical Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; 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.