Active NPI
Jack Copeland, MD
- Surgery Physician
- San Diego, CA
National Provider Identifier
1730152786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 9927
- Practice address
- 200 W. Arbor Dr.
MC 8892
San Diego, CA 92103 - Phone
- (619) 543-7777
- Fax
- (619) 543-2652
- NPI assigned
- Feb 9, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 9927 | AZ | Primary |
Addresses
Primary practice location
200 W. Arbor Dr.
MC 8892
San Diego, CA 92103
Mailing address
200 W. Arbor Dr.
MC 8892
San Diego, CA 92103
Phone (619) 543-7777
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 330002923 | Other | AZ | RR MEDICARE |
| 220997 | Medicaid | AZ |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 9927 | AZ | MD | Physical Therapy Assistant |
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": "1306800000000",
"number": "1730152786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W. ARBOR DR.",
"address_2": "MC 8892",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92103",
"telephone_number": "619-543-7777",
"fax_number": "619-543-2652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W. ARBOR DR.",
"address_2": "MC 8892",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92103",
"telephone_number": "619-543-7777",
"fax_number": "619-543-2652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPELAND",
"first_name": "JACK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-09",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "9927",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "330002923",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "220997",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.