Individual provider Active NPI

Sidney Cook, FNP

  • Family Nurse Practitioner
  • Southaven, MS
National Provider Identifier
1508148990
Registry record updated Mar 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R854897 Issued in MS
Practice address
3451 Goodman Rd E Ste 115
Southaven, MS 38672-9304
Phone
(662) 890-5555
Fax
(662) 890-8899
NPI assigned
Sep 13, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R854897 MS Primary

Addresses

Primary practice location

3451 Goodman Rd E Ste 115
Southaven, MS 38672-9304

Mailing address

3451 Goodman Rd E Ste 115
Southaven, MS 38672-9304
Phone (662) 890-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120417000422 MS Practitioner - Nurse Practitioner 3072774140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medical Clinic of North Ms IncGroup PAC ID 5294790861, 13 clinicians

Practice addresses (Care Compare)

3451 Goodman Rd E
Suite 115
Southaven, MS 38672-9304
Phone (662) 890-5555

Hospital & facility affiliations

  • Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
  • Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
15966TNMDPhysical Therapist
R854897MSMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: sidney.cook.1@14940.direct.athenahealth.com
  • Direct secure messaging: shonecook@fmconm-ms.direct.office.nextgen.com

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1508148990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 115",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729304",
            "telephone_number": "662-890-5555",
            "fax_number": "662-890-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 115",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729304",
            "telephone_number": "662-890-5555",
            "fax_number": "662-890-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "SIDNEY",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R854897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.