Charles Frederick Cockerell, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

R9052 Issued in MO

Practice address

205 W R D Mize Rd
Suite 304
Blue Springs, MO 64014-2518

Phone

(816) 228-4770

Fax

(816) 228-1156

NPI assigned

Jul 7, 2005

Last updated

Aug 27, 2012By 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 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Mercy-Cockerell and McIntosh Pediatrics, Inc

  • Pediatrics Physician
  • Blue Springs, MO
  • NPI 1811528656
  NPD (past)
• Cockerell & McIntosh Pediatric Urgent Care PC

  • Urgent Care Clinic/Center
  • Independence, MO
  • NPI 1437180171
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346025600000",
    "number": "1740287549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W R D MIZE RD",
            "address_2": "SUITE 304",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142518",
            "telephone_number": "816-228-4770",
            "fax_number": "816-228-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W R D MIZE RD",
            "address_2": "SUITE 304",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142518",
            "telephone_number": "816-228-4770",
            "fax_number": "816-228-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COCKERELL",
        "first_name": "CHARLES",
        "middle_name": "FREDERICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "R9052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY HEALTH PARTNERS",
            "identifier": "202400",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY HEALTH PARTNERS",
            "identifier": "202401",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "07973031",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST GUARD",
            "identifier": "312720",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4001376",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1208133",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200110211",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CMC Comprehensive Care Blue Springs LLC (Core Medical Center)
• CMC Physical and Occupational Therapy
• CMC Walk in Med BS LLC (CMC Walk in Medical)
• Cockerell & McIntosh Pediatrics PC
• Cockerell & McIntosh Pediatrics, PC
• Heather Lynn Colbert
• Tatum Brianne Colburn, DO
• Sara Jane Cole, PSY.D.
• Glenn Mark Collet, PSYCHOLOGIST
• Collier Care Home, Inc

• Pediatrics Physician in Blue Springs, MO
• Providers in Blue Springs, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.