Active NPI
Thomas W Cooper, MD
- Otolaryngology Physician
- Tyler, TX
National Provider Identifier
1770556516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- D6992
- Practice address
- 630 S Fleishel Ave
Tyler, TX 75701-2041 - Phone
- (903) 533-1491
- NPI assigned
- Feb 10, 2006
- Last updated
- Oct 10, 2014
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | D6992 | TX | Primary |
Addresses
Primary practice location
630 S Fleishel Ave
Tyler, TX 75701-2041
Mailing address
PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010064699 | Other | TX | MEDICARE RAILROAD |
| 123038 | Other | TX | CHIPS |
| 752616977015 | Other | TX | TRICARE |
| 752616977010 | Other | TX | TRICARE |
| 4380144 | Other | TX | AETNA |
| 141088801 | Medicaid | TX | |
| 752616977009 | Other | TX | TRICARE CHAMPUS |
| CO088865G | Other | TX | BCBS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412899200000",
"number": "1770556516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 846098",
"city": "DALLAS",
"state": "TX",
"postal_code": "752846098",
"telephone_number": "903-324-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S FLEISHEL AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012041",
"telephone_number": "903-533-1491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "THOMAS",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2014-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TX",
"license": "D6992",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "010064699",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIPS",
"identifier": "123038",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "752616977015",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "752616977010",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4380144",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "141088801",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE CHAMPUS",
"identifier": "752616977009",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "CO088865G",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.