Richard Cooley III, DO
Individual provider Active NPI Specialist · Negaunee, MI
NPI 1467514992 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1467514992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 5101013819 (MI)
- Practice address
- 100 Malton St
Ste 4
Negaunee, MI 49866-2001 - Phone
- (906) 475-7838
- Fax
- (906) 486-6898
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050412001306 | MI | Practitioner - Hospitalist |
0840237756 | Reassigns benefits to 1 organization |
| I20190313001356 | WI | Practitioner - Hospitalist | 0840237756 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101013819 | MI | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clare Memorial Hospital, Inc | Current |
Accepting new patients | |
| Sound Inpatient Physicians-Michigan, PLLC | Current |
Accepting new patients | |
| St. Clare Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Sound Inpatient Physicians - Michigan, PLLC | Current |
Accepting new patients | |
| Bell Medical Center | Past |
Accepting new patients |
Locations
580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131
855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 5101013819 | MI | Yes |
Addresses
Primary practice location
100 Malton St
Ste 4
Negaunee, MI 49866-2001
Mailing address
100 Malton St
Ste 4
Negaunee, MI 49866-2001
Phone (906) 475-7838
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00184525 | Other | MI | RRMEDICARE |
| RC013819 | Other | MI | BCBS LICENSE |
Other providers in Negaunee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.