Individual provider Active NPI

Michael Townsend Cooper Jr., M.D.

  • Pediatrics Physician
  • Brunswick, GA
National Provider Identifier
1225079452
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
054478 Issued in GA
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, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
181268695AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150129002158 OK Practitioner - Pediatric Medicine 1456675057 Reassigns benefits to 1 organization
I20200804000980 TX Practitioner - Pediatric Medicine 1456675057 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
054478GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Jan 19, 2015 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Jul 28, 2020 Accepting new patients
Choctaw Nation of Oklahoma Current Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Jul 28, 2020 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Jan 19, 2015 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

  • Direct secure messaging: 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.

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

Sources for this page

Verify at the official NPI Registry.