Individual provider Active NPI

Wendy Cooper, M.D.

  • Internal Medicine Physician
  • Waukesha, WI
National Provider Identifier
1720051824
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28143 Issued in WI
Practice address
N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates Inc.
Waukesha, WI 53188-1135
Phone
(262) 549-3030
NPI assigned
Feb 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28143 WI Primary
Pediatrics Physician 208000000X 28143 WI

Addresses

Primary practice location

N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates Inc.
Waukesha, WI 53188-1135

Mailing address

N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates Inc.
Waukesha, WI 53188-1135
Phone (262) 549-3030

Other identifiers 1

IdentifierTypeStateIssuer
30780600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28143WIMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1720051824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N14W23900 STONE RIDGE DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES INC.",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881135",
            "telephone_number": "262-549-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N14W23900 STONE RIDGE DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES INC.",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881135",
            "telephone_number": "262-549-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "WENDY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "28143",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "28143",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30780600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.