NPIMap

Organization Active NPI

Cooper Family Medical Center Inc.

  • Clinic/Center
  • Pascagoula, MS
National Provider Identifier
1356478564
Registry record updated Oct 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
13038 Issued in MS
Legal business name
COOPER FAMILY MEDICAL CENTER INC.
Practice address
4305 Denny Ave
Pascagoula, MS 39581-5509
Phone
(228) 762-2044
Fax
(228) 762-2064
NPI assigned
Feb 27, 2007
Last updated
Oct 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2017

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

Authorized official

Name
Dr. Kevin S. Cooper, MD, MPHNPI 1023267630
Title
President
Phone
(228) 762-2044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 13038 MS Primary

Addresses

Primary practice location

4305 Denny Ave
Pascagoula, MS 39581-5509

Mailing address

4305 Denny Ave
Pascagoula, MS 39581-5509
Phone (228) 762-2044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081014000361 MS Part B Supplier - Clinic/Group Practice 2860560125 Receives reassigned benefits from 3 practitioners
Practice locations: Pascagoula, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1044207Cooper Family Med4305 Denny Ave, Pascagoula, MS 39581Certificate of waiverAug 14, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508889600000",
    "number": "1356478564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815509",
            "telephone_number": "228-762-2044",
            "fax_number": "228-762-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815509",
            "telephone_number": "228-762-2044",
            "fax_number": "228-762-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER FAMILY MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2017-10-25",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-762-2044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "13038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; 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.