Active NPI
Sarah Kooper-Johnson
- Dermatology Physician
- Brockton, MA
National Provider Identifier
1649039694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 3018664
- Practice address
- 680 Centre St
Brockton, MA 02302-3308 - Phone
- (508) 941-7210
- NPI assigned
- Mar 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 3018664 | MA | Primary |
Addresses
Primary practice location
680 Centre St
Brockton, MA 02302-3308
Mailing address
30 Caldwell St Unit 214
Charlestown, MA 02129-1220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251118000952 | MA | Order and Referring Only - Dermatology | 2668963604 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3018664 | MA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778544000000",
"number": "1649039694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 CALDWELL ST UNIT 214",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021291220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 CENTRE ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023023308",
"telephone_number": "508-941-7210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOPER-JOHNSON",
"first_name": "SARAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-13",
"last_updated": "2026-05-12",
"certification_date": "2026-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": "3018664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; 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.