Individual provider Active NPI

Jo A Cooke-Barber, M.D.

  • Pediatric Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1417215922
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
01094198A Issued in IN
Practice address
7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182
Phone
(260) 469-7337
Fax
(260) 469-7340
NPI assigned
May 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 74214 GA
Pediatric Surgery Physician 2086S0120X 01094198A IN Primary

Addresses

Primary practice location

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182

Mailing address

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182
Phone (260) 469-7337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240710001779 IN Practitioner - General SurgeryPractitioner - Pediatric Medicine 6901109909 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74214GAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Pediatric Surgeons, Inc. Pediatric Surgery CurrentSince Aug 1, 2024 Accepting new patients

Locations

7613 W Jefferson Blvd
Ste 200
Fort Wayne, IN 46804
Phone (260) 469-7337

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": "1336003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1417215922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOKE-BARBER",
        "first_name": "JO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-03",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "74214",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IN",
            "license": "01094198A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.