Jac Alan Cooper Sr., M.D.

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

01035869A Issued in IN

Practice address

85 E US Highway 6 Ste 240
Valparaiso, IN 46383

Phone

(219) 983-6240

Fax

(219) 983-6040

NPI assigned

Jun 17, 2005

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 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: jac.cooper.1@2340.direct.athenahealth.com

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1760487425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 KELLE DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463048708",
            "telephone_number": "219-364-3616",
            "fax_number": "219-364-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E US HIGHWAY 6 STE 240",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "46383",
            "telephone_number": "219-983-6240",
            "fax_number": "219-983-6040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Roosevelt Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832801",
            "country_code": "US",
            "telephone_number": "219-983-6240",
            "fax_number": "219-983-6040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3630 Willowcreek Rd",
            "address_2": "Ste 3",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685075",
            "country_code": "US",
            "telephone_number": "219-759-4577",
            "fax_number": "219-759-3564",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3630 Willowcreek Rd",
            "address_2": "Ste 3",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685075",
            "country_code": "US",
            "telephone_number": "219-759-4577",
            "fax_number": "219-759-3564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOPER",
        "first_name": "JAC",
        "middle_name": "ALAN",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IN",
            "license": "01035869A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100207020",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000082449",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jac.cooper.1@2340.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "85 E US Highway 6 Ste 240",
            "city": "Valparaiso",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Connecting Pieces LLC
• Diane Conover
• Hailey Cook
• Richard Allen Cook, CADAC III
• Charles Cooper, DNP CRNA
• Latonya R Cooper, LCSW
• Stewart E. Cooper, PHD
• Jilissa Copeland, LCSW
• Adam Laurence Cordray, DO
• Corner Sun Wellness, LLC

• Surgical Critical Care Physician in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Surgical Critical Care Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.