Deidra K Cockroft, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1152 Issued in MS

Practice address

130 Parkway PLZ
Kosciusko, MS 39090-3217

Phone

(662) 289-3588

Fax

(662) 289-3533

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

No

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

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Medical Group of Mississippi LLCGroup PAC ID 8729973623, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Medical Group of Mississippi LLC

  • Clinic/Center
  • Kosciusko, MS
  • NPI 1790827038
  Medicare reassignment Care Compare group NPD
• Premier Medical Group of Mississippi LLC

  • Clinic/Center
  • Jackson, MS
  • NPI 1548219884
  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1265495154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23996",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253996",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PARKWAY PLZ",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903217",
            "telephone_number": "662-289-3588",
            "fax_number": "662-289-3533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Ridgewood Cir",
            "address_purpose": "LOCATION",
            "city": "Kosciusko",
            "state": "MS",
            "postal_code": "390903226",
            "country_code": "US",
            "telephone_number": "662-290-3370",
            "fax_number": "662-290-0821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COCKROFT",
        "first_name": "DEIDRA",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT1152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01584323",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenyatta Chambers
• Ronnie S Christian, MD
• Cochran Optical Dispensary
• Gary A Cochran
• Sandy Heath Cockrell
• Linda B Cockroft, FNP
• Ray Scott Cockroft, OT
• Jordan L Courts
• Crescent City Surgical Centre Diagnostics, LLC
• Annette Cross, FNP

• Physical Therapist in Kosciusko, MS
• Providers in Kosciusko, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.