Cooper Bufkin Moore, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

44 715 Issued in MS

Practice address

1151 N State St Ste 212
Jackson, MS 39202-2467

Phone

(601) 352-7398

Fax

(601) 352-0442

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Teton County Hospital DistrictGroup PAC ID 4880582295, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Teton County Hospital District

  • General Practice Physician
  • Jackson, WY
  • NPI 1487818605
  Medicare reassignment Care Compare group NPD
• Live Oak Psychological Associtaes

  • Clinical Psychologist
  • Jackson, MS
  • NPI 1750577805
  NPD (past)

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

• Teton County Hospital District

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  Care Compare affiliation

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710011150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 N STATE ST STE 212",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 N STATE ST STE 212",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022467",
            "telephone_number": "601-352-7398",
            "fax_number": "601-352-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "COOPER",
        "middle_name": "BUFKIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "44 715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheena Moore-Carter, FNP
• Alan Rather Moore, MD
• Andrea Moore, FNP-BC
• Bridgett Moore
• Candice M. Moore, OTR L
• Daniel Moore
• Derrick Michael Moore, LMSW
• Dusharme Lakiva-Ann Moore, NP
• Ellyssya B Moore, BCBA
• Gambrell Moore

• Clinical Psychologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Psychologist in Mississippi

• 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.