Charles Marcus Cooper, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1084 Issued in TN

Practice address

101 Med Tech Pkwy
Johnson City, TN 37604-4007

Phone

(423) 232-6120

NPI assigned

Jun 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Clinical Psychologist

Education

University of South Carolina School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialists in Pain Management, PLLC Dba Spine and Pain AssociatesGroup PAC ID 1355253659, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: c.cooper.1@30188.direct.athenahealth.com

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.

• Specialists in Pain Management, PLLC Dba Spine & Pain Associates

  • Interventional Pain Medicine Physician
  • Chattanooga, TN
  • NPI 1447203922
  Medicare reassignment Care Compare group NPD
• Pain Medicine Associates, P.C.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Johnson City, TN
  • NPI 1477594364
  Medicare reassignment NPD
• Pain Medicine Associates, P.C.

  • Psychologist
  • Johnson City, TN
  • NPI 1962655696
  NPD
• Specialists in Pain Management, PLLC Dba Spine & Pain Associates

  • Prosthetic/Orthotic Supplier
  • Cleveland, TN
  • NPI 1134872922
  NPD
• Anesthesia and Pain Consultants,P.C.

  • Anesthesiology Physician
  • Johnson City, TN
  • NPI 1750399127
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699703835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "CHARLES",
        "middle_name": "MARCUS",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "1084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS (MENTAL HEALTH",
            "identifier": "4010675",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0107",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM JC",
            "identifier": "186693",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARITEN",
            "identifier": "14722",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3584891",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7241087",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM (KPT)",
            "identifier": "186690",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS (MEDICAL)",
            "identifier": "4104023",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy P Cook, PA-C
• Charles P. Cooley, FNP
• Amber Celeste Coomer, MSN, RN
• John Cooney, DO
• Casilyn B Cooper
• Coty Cooper, MD
• Ernest W. Cooper, D.D.S.
• Monica L Cooper
• Scott Bryson Cooper, M.D.
• Rebecca J Copeland, MD

• Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.