Carissa Ann Coorough, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2872-23 Issued in WI

Practice address

720 S Van Buren St Ste 301
Green Bay, WI 54301-3534

Phone

(920) 433-9400

NPI assigned

Oct 12, 2011

Last updated

Jul 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carissa Ann Cole Former name

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Wisconsin Medical Foundation, Inc

  • Multi-Specialty Clinic/Center
  • Middleton, WI
  • NPI 1598784555
  Medicare reassignment NPD
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115
  Medicare reassignment
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Hamilton Clinic

  • Clinic/Center
  • La Crosse, WI
  • NPI 1225873458
  Medicare reassignment
• Urology Associates of Green Bay, S.C.

  • Specialist
  • De Pere, WI
  • NPI 1427067263
  Medicare reassignment
• Gundersen Clinic LTD

  dba Gundersen Health System la Crosse North Building

  • Clinic/Center
  • La Crosse, WI
  • NPI 1952915639
  NPD
• Gundersen Lutheran Express Care, Inc

  • Clinic/Center
  • La Crosse, WI
  • NPI 1043446974
  NPD
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health Onalaska Clinic

  • Clinic/Center
  • Onalaska, WI
  • NPI 1225372923
  NPD
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health Onalaska Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Onalaska, WI
  • NPI 1871837567
  NPD
• University of Wisconsin Medical Foundation, Inc

  • Health Educator
  • Madison, WI
  • NPI 1487414082
  NPD

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

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1588949333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S VAN BUREN ST STE 301",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013534",
            "telephone_number": "920-433-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S VAN BUREN ST STE 301",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013534",
            "telephone_number": "920-433-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOROUGH",
        "first_name": "CARISSA",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-12",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2872-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "COLE",
            "middle_name": "ANN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donald Ray Cooley Jr., DPT, ATC
• Karen Cooley, PT, DPT
• Wendy N Coolman, APRN
• Timothy R Cooper, MD
• Trevor Lynn Cooper
• Nicholas Edward Coorough, M.D.
• Vicky Coppens, CAPSW
• Marissa Lee Coppersmith, NP
• Sarah M Coppin, DPT
• Kamie Marie Corbiere Swanson, OT

• Physician Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.

Verify at the official NPI Registry.