Active NPI
Michael Townsend Cooper Jr., M.D.
- Pediatrics Physician
- Brunswick, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 054478
- Practice address
- 3208 Shrine Rd
Brunswick, GA 31520-4325 - Phone
- (912) 265-2036
- Fax
- (912) 265-6779
- NPI assigned
- Jun 9, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 054478 | GA | Primary |
Addresses
Primary practice location
3208 Shrine Rd
Brunswick, GA 31520-4325
Mailing address
3208 Shrine Rd
Brunswick, GA 31520-4325
Phone (912) 265-2036
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 181268695A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054478 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Board of Regents of the University of Oklahoma - Ou Physicians | Current | Accepting new patients | |
| Choctaw Nation of Oklahoma | Current | Accepting new patients | |
| Choctaw Nation of Oklahoma | Current | Accepting new patients | |
| Choctaw Nation of Oklahoma | Current | Accepting new patients | |
| Board of Regents of the University of Oklahoma - Ou Physicians | Current | Accepting new patients | |
| Pediatric Associates of Brunswick | Pediatrics | Past | Accepting new patients |
Locations
1300 E Martin Luther King Dr
Broken Bow, OK 74728
Phone (580) 208-2204
410 N M St
Hugo, OK 74743
Phone (580) 326-7561
902 E Lincoln Rd
Idabel, OK 74745
Phone (580) 286-2600
1127 S George Nigh Expy
McAlester, OK 74501
Phone (800) 349-7026
420 SW 10th St
Oklahoma City, OK 73109
Phone (405) 236-0701
825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864
109 Kerr Blvd
Poteau, OK 74953
Phone (918) 649-1100
2204 E Main St
Stigler, OK 74462
Phone (918) 967-9200
1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440
205 Dallas St
Talihina, OK 74571
Phone (918) 567-3636
Interoperability endpoints
- mcooper19870@choctawnation.direct-ci.com
Organizations & group practices 6
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.
-
- Multi-Specialty Clinic/Center
- Oklahoma City, OK
- NPI 1801869250
-
dba Choctaw Nation Health Care
- Rural Acute Care Hospital
- Talihina, OK
- NPI 1659347623
TX
-
- Multi-Specialty Clinic/Center
- Edmond, OK
- NPI 1124646971
-
dba Choctaw Nation Health Clinic - Broken Bow
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Broken Bow, OK
- NPI 1447143532
-
dba Choctaw Nation Health Clinic-Broken Bow
- Primary Care Clinic/Center
- Broken Bow, OK
- NPI 1770559619
-
- Pediatrics Physician
- Brunswick, GA
- NPI 1942333588
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225079452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3208 SHRINE RD",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "315204325",
"telephone_number": "912-265-2036",
"fax_number": "912-265-6779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3208 SHRINE RD",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "315204325",
"telephone_number": "912-265-2036",
"fax_number": "912-265-6779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "MICHAEL",
"middle_name": "TOWNSEND",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "054478",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "181268695A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brunswick, GA
- James K Conlan, MD
- Consultants in Pain Medicine, LLC (Centurion Spine & Pain Centers)
- Ryan A. Conwell, DPT
- Tanya Cook, RN
- Douglas Thurman Cooper, M.D.
- Cooperative Healthcare Services Inc (Southeast Georgia Physician Associates)
- Cooperative Healthcare Services, Inc. (Southeast Georgia Health System ENT Surgical Center)
- Cooperative Rehab Services, LLC
- Costal Georgia Vein Center Inc.
- Costrini & Meadows PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.