Active NPI
Scott Ellis Kooperman, MD
- Anesthesiology Physician
- Tampa, FL
National Provider Identifier
1558366310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 30200
- Practice address
- 9312 Deer Creek Dr
Tampa, FL 33647-2286 - Phone
- (813) 575-9993
- Fax
- (813) 575-9993
- NPI assigned
- Jun 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 110838 | FL | |
| Anesthesiology Physician | 207L00000X | 30200 | KY | Primary |
Addresses
Primary practice location
9312 Deer Creek Dr
Tampa, FL 33647-2286
Mailing address
9312 Deer Creek Dr
Tampa, FL 33647-2286
Phone (813) 575-9993
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64030208 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110838 | FL | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GLHS Anesthesia Group | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Lafayette, IN
- NPI 1588673560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635724800000",
"number": "1558366310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9312 DEER CREEK DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336472286",
"telephone_number": "813-575-9993",
"fax_number": "813-575-9993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9312 DEER CREEK DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336472286",
"telephone_number": "813-575-9993",
"fax_number": "813-575-9993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOPERMAN",
"first_name": "SCOTT",
"middle_name": "ELLIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2021-11-01",
"certification_date": "2021-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "FL",
"license": "110838",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "KY",
"license": "30200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64030208",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.