Mary Alice Cooper, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

92-201 Issued in NM

Practice address

204 Carlisle Blvd NE
Albuquerque, NM 87106-1317

Phone

(505) 266-6522

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 3, 2016 through Feb 3, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1205978970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 CARLISLE BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061317",
            "telephone_number": "505-266-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 CARLISLE BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061317",
            "telephone_number": "505-266-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MARY ALICE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "92-201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E6567",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine L Cooper, PHARM.D.
• Janet Marie Cooper
• Kimberly Horvath Cooper
• Kristin Herrnstein Cooper
• Levi Owen Cooper
• Morley Phillips Cooper, O.D.
• Regina C Cooper, SLP
• Rosalind M Cooper, SLP
• Cooperative Educational Services
• Sharon Cooperman

• Family Medicine Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.