NPIMap

Individual provider Active NPI

Jimmy Cooper Jr., DHA, FNP-C

  • Family Nurse Practitioner
  • Portsmouth, VA
National Provider Identifier
1205123171
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024169299 Issued in VA
Practice address
3520 High St Ste 100
Portsmouth, VA 23707-3126
Phone
(757) 338-4012
NPI assigned
Jun 29, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024169299 VA Primary

Addresses

Primary practice location

3520 High St Ste 100
Portsmouth, VA 23707-3126

Mailing address

3520 High St Ste 100
Portsmouth, VA 23707-3126
Phone (757) 977-9675

Other practice location 1

3001 Churchland Blvd
Chesapeake, VA 23321-5603
Phone (757) 977-9675

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111027000602 VA Practitioner - Nurse Practitioner 9234302795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Mobile Medicine PLLCGroup PAC ID 9739435066, 3 clinicians

Practice addresses (Care Compare)

5809 Pleasant Woods CT
Portsmouth, VA 23703-1550
Phone (757) 338-4012

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Mobile Medicine, PLLC CurrentSince Jun 27, 2018 Accepting new patients

Locations

3001 Churchland Blvd
Chesapeake, VA 23321
Phone (757) 761-3921

3520 High St
#100
Portsmouth, VA 23707
Phone (757) 738-1900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CBGEDD/Endpoint/CBGEDD

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.

Hospital & facility affiliations 9

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": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1205123171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 HIGH ST STE 100",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073126",
            "telephone_number": "757-977-9675",
            "fax_number": "757-483-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 HIGH ST STE 100",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073126",
            "telephone_number": "757-338-4012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 Churchland Blvd",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233215603",
            "country_code": "US",
            "telephone_number": "757-977-9675",
            "fax_number": "757-483-8099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOPER",
        "first_name": "JIMMY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DHA, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-29",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024169299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.