Mark Anthony Cooper Jr.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA62888 Issued in CA

Practice address

1731 E 120TH St
Los Angeles, CA 90059-3051

Phone

(323) 563-4800

NPI assigned

Feb 13, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Domenick J Sisto M D IncGroup PAC ID 0648230292, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Cedars Sinai Tarzana Medical Center Hospital, Tarzana, CA, CCN 050761
• Sherman Oaks Hospital Hospital, Sherman Oaks, CA, CCN 050755
• Palmdale Regional Medical Center Hospital, Palmdale, CA, CCN 050204

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: mcooper@laoi1795.srs-direct.com

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.

• Domenick J Sisto M D Inc

  • Specialist
  • Palmdale, CA
  • NPI 1710941539
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lancaster Hospital Corporation

  • General Acute Care Hospital
  • Palmdale, CA
  • NPI 1508856535
  Care Compare affiliation
• Prime Healthcare Services - Sherman Oaks, LLC

  • General Acute Care Hospital
  • Sherman Oaks, CA
  • NPI 1750491247
  Care Compare affiliation
• Tarzana Medical Center LLC

  • General Acute Care Hospital
  • Tarzana, CA
  • NPI 1821250762
  Care Compare affiliation

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

{
    "created_epoch": "1644710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1336894914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051",
            "telephone_number": "323-563-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-13",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA62888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Cooper
• Kerry Dale Cooper
• Khidell Cooper
• Lanae Cooper
• Leroy Cooper, P.A.
• Martin Cooper, M.D.
• Merchuria Cooper
• Michael Ross Cooper, D.C.
• Odelia Cooper, M.D.
• Rachel Margaret Cooper, MD

• Medical Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.
• 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.