Individual provider Active NPI

Gregory A Cook Sr., DDS

  • Dentist
  • Beachwood, OH
National Provider Identifier
1386705531
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30016049 Issued in OH
Practice address
3365 Richmond Rd
Suite 220
Beachwood, OH 44122-4171
Phone
(216) 831-1816
Fax
(216) 755-1313
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30016049 OH Primary

Addresses

Primary practice location

3365 Richmond Rd
Suite 220
Beachwood, OH 44122-4171

Mailing address

3365 Richmond Rd
Suite 220
Beachwood, OH 44122-4171
Phone (216) 831-1816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160113001740 OH Order and Referring Only - DentistPractitioner - Dentist 9931401577

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30016049OHMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386705531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3365 RICHMOND RD",
            "address_2": "SUITE 220",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224171",
            "telephone_number": "216-831-1816",
            "fax_number": "216-755-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3365 RICHMOND RD",
            "address_2": "SUITE 220",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224171",
            "telephone_number": "216-831-1816",
            "fax_number": "216-755-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "GREGORY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30016049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

Verify at the official NPI Registry.