Individual provider Active NPI

Jay D Cook, M.D.

  • Specialist
  • Mesa, AZ
National Provider Identifier
1447287040
Registry record updated Nov 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
35460 Issued in AZ
Practice address
1432 S Dobson Rd
Suite 301
Mesa, AZ 85202-4768
Phone
(480) 464-9400
Fax
(480) 464-9401
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 35460 AZ Primary

Addresses

Primary practice location

1432 S Dobson Rd
Suite 301
Mesa, AZ 85202-4768

Mailing address

PO Box 40487
Mesa, AZ 85274-0487
Phone (480) 464-9400

Other identifiers 1

IdentifierTypeStateIssuer
151185MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20191021002518 TN Practitioner - Pediatric MedicinePractitioner - Psychiatry 7618975921 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation Family Medicine CurrentSince Jun 24, 2019 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Jun 24, 2019 Accepting new patients

Locations

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

408 N State of Franklin Rd
Ste 31
Johnson City, TN 37604
Phone (423) 431-2477

Organizations & group practices 3

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289260800000",
    "number": "1447287040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40487",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852740487",
            "telephone_number": "480-464-9400",
            "fax_number": "480-464-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 S DOBSON RD",
            "address_2": "SUITE 301",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024768",
            "telephone_number": "480-464-9400",
            "fax_number": "480-464-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JAY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2010-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "35460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151185",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.