Trace Cooper, DO STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1401 E Central Dr
Meridian, ID 83642-8046

Phone

(208) 795-4266

NPI assigned

Apr 4, 2024

Last updated

Apr 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1326890096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E CENTRAL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E CENTRAL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428046",
            "telephone_number": "208-795-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "TRACE",
        "credential": "DO STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Robert Cooley, DMD
• Kaitlin Cooley, FNP-C
• Weslie Cooley, CPNP-PC
• Christine Cooper
• Cypress April Cooper, NP
• Dyana Marie Coose
• Adam M Cope, MPT
• Katie E Copeland, M.D.
• Copper Creek Counseling Center, LLC
• Copper Falls Hospice LLC

• Student in an Organized Health Care Education/Training Program in Meridian, ID
• Providers in Meridian, ID by specialty
• Student in an Organized Health Care Education/Training Program in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.

Verify at the official NPI Registry.