Individual provider Active NPI

Stewart Cooper, MD

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1396737508
Registry record updated Apr 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9800029 Issued in NC
Practice address
3020 Bonbrook Dr
Winston Salem, NC 27106-3020
Phone
(336) 713-5393
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9800029 NC Primary

Addresses

Primary practice location

3020 Bonbrook Dr
Winston Salem, NC 27106-3020

Mailing address

PO Box 602658
Charlotte, NC 28260-2658
Phone (336) 716-2011

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20080617000696 NC Practitioner - Family Practice 9638240732 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9800029NCMDFamily Medicine Physician

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1396737508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602658",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602658",
            "telephone_number": "336-716-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 BONBROOK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063020",
            "telephone_number": "336-713-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "STEWART",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9800029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.