NPIMap

Individual provider Active NPI

Courtney Jane Cockerell, D.O

  • Gastroenterology Physician
  • Fenton, MO
National Provider Identifier
1346504644
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2015021511 Issued in MO
Practice address
1011 Bowles Ave Ste 425
Fenton, MO 63026-2384
Phone
(636) 496-5030
NPI assigned
Jul 2, 2012
Sex
Female
Sole proprietor
No

Organizations & group practices 10

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.

Hospital & facility affiliations 4

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

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group Inc 565 clinicians

Practice addresses (Care Compare)

1011 Bowles Ave
Suite 425
Fenton, MO 63026-2384
Phone (636) 496-5030

Hospital & facility affiliations

  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • SSM Health St Mary'S Hospital - St Louis Hospital, Saint Louis, MO, CCN 260091
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy54
Upper gastrointestinal (GI) endoscopy for acid reflux105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20150805007348 MO Practitioner - GastroenterologyPractitioner - Internal Medicine 3173837002 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. Gastroenterology CurrentSince Aug 1, 2019 Accepting new patients
SSM Medical Group Inc. CurrentSince Aug 1, 2019 Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

3221 McKelvey Rd
Ste 301
Bridgeton, MO 63044

1011 Bowles Ave
Ste 205
Fenton, MO 63026
Phone (314) 966-8118

1011 Bowles Ave
Ste 425
Fenton, MO 63026
Phone (636) 326-2600

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

Interoperability endpoints

  • Direct secure messaging: ccockerell315462@direct-ehr-ssmhc.com

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X 2015021511 MO Primary

Addresses

NPPES NPI Registry

Primary practice location

1011 Bowles Ave Ste 425
Fenton, MO 63026-2384

Mailing address

PO Box 955534
Saint Louis, MO 63195-1840

Other practice location 1

1402 S Grand Blvd
FDT 14th Floor
Saint Louis, MO 63104-1004
Phone (314) 577-8762

Electronic endpoints 2

NPPES NPI Registry
TypeEndpointUseAffiliation
Direct Messaging Address ccockerell315462@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 20, 2020.

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1346504644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631951840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 425",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262384",
            "telephone_number": "636-496-5030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1402 S Grand Blvd",
            "address_2": "FDT 14th Floor",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041004",
            "country_code": "US",
            "telephone_number": "314-577-8762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COCKERELL",
        "first_name": "COURTNEY",
        "middle_name": "JANE",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-02",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2015021511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccockerell315462@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ccockerell315462@direct-ehr-ssmhc.com",
            "address_1": "1011 Bowles Ave Ste 425",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262384",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR  API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1011 Bowles Ave Ste 425",
            "city": "Fenton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630262384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.