Individual provider Active NPI

Andrea R. Cooper, APRN.CNM, APRN.CNP

  • Advanced Practice Midwife
  • Gahanna, OH
National Provider Identifier
1508116203
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
APRN.CNM.13981 Issued in OH
Practice address
920 N Hamilton Rd
Gahanna, OH 43230-1757
Phone
(614) 293-3069
Fax
(614) 366-0894
NPI assigned
Sep 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN.CNP.14052 OH
Advanced Practice Midwife 367A00000X APRN.CNM.13981 OH Primary

Addresses

Primary practice location

920 N Hamilton Rd
Gahanna, OH 43230-1757

Mailing address

700 Ackerman Rd Ste 570
Columbus, OH 43202-1579
Phone (614) 293-3069

Other identifiers 1

IdentifierTypeStateIssuer
0075201MedicaidOH

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121212000518 OH Practitioner - Certified Nurse Midwife (CNM) 0547412801 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
APRN.CNP.14052OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc CurrentSince Aug 31, 2016 Accepting new patients
Lake Hospital System Inc Nurse Practitioner CurrentSince Aug 31, 2016 Accepting new patients
Osu Internal Medicine, LLC Past Accepting new patients

Locations

9485 Mentor Ave
Ste 202
Mentor, OH 44060
Phone (440) 205-5862

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

36001 Euclid Ave
Ste C7
Willoughby, OH 44094
Phone (440) 602-6710

36000 Euclid Ave
Willoughby Hills, OH 44094
Phone (440) 375-8166

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": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1508116203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 570",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021579",
            "telephone_number": "614-293-3069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 N HAMILTON RD",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432301757",
            "telephone_number": "614-293-3069",
            "fax_number": "614-366-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "ANDREA",
        "middle_name": "R.",
        "credential": "APRN.CNM, APRN.CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-11",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.14052",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OH",
            "license": "APRN.CNM.13981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075201",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gahanna, OH

Sources for this page

Verify at the official NPI Registry.