Active NPI
Jason William Cooper, DDS
- General Practice Dentistry
- Gary, IN
National Provider Identifier
1215261201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8827
- Practice address
- 3506 Village CT
Gary, IN 46408-1428 - Phone
- (219) 985-3133
- NPI assigned
- Sep 24, 2009
- 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 Dentistry | 1223G0001X | 8827 | KY | Primary |
Addresses
Primary practice location
3506 Village CT
Gary, IN 46408-1428
Mailing address
201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (719) 562-4447
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117000495 | IN | Order and Referring Only - Dentist | 1052690955 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8827 | KY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293494400000",
"number": "1215261201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W 8TH ST",
"address_2": "SUITE 810",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033038",
"telephone_number": "719-562-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3506 VILLAGE CT",
"city": "GARY",
"state": "IN",
"postal_code": "464081428",
"telephone_number": "219-985-3133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "JASON",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-24",
"last_updated": "2010-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "8827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.