Individual provider Active NPI

Susannah Catherine Cooper, MD

  • Hematology & Oncology Physician
  • Tucson, AZ
National Provider Identifier
1790846038
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
62128 Issued in AZ
Practice address
1620 W Saint Marys Rd
Tucson, AZ 85745-2624
Phone
(520) 624-7445
Fax
(520) 623-6145
NPI assigned
Dec 12, 2006
Last updated
Jul 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X R5850 TX
Hematology & Oncology Physician 207RH0003X 0101242150 VA
Hematology & Oncology Physician 207RH0003X 62128 AZ Primary
Hematology & Oncology Physician 207RH0003X 60670 TN

Addresses

Primary practice location

1620 W Saint Marys Rd
Tucson, AZ 85745-2624

Mailing address

PO Box 910221
Dallas, TX 75391-0221
Phone (520) 519-7700

Other identifiers 1

IdentifierTypeStateIssuer
Q055008MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200309002567 TN Practitioner - Hematology/Oncology 1658556899 Reassigns benefits to 1 organization
I20240904001586 VA Practitioner - Hematology/Oncology 1658556899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians

Practice addresses (Care Compare)

1280 Main St a
Altavista, VA 24517-1465
Phone (434) 309-1165

1701 Thomson Dr
Lynchburg, VA 24501-1118
Phone (434) 200-4522

1901 Tate Springs Rd
Lynchburg, VA 24501-1109
Phone (434) 947-3033

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Thompson Oncology Group Hematology & Oncology CurrentSince Jan 1, 2020 Accepting new patients
Centra Medical Group, LLC CurrentSince Aug 1, 2024 Accepting new patients

Locations

1915 White Ave
Knoxville, TN 37916
Phone (423) 977-1065

Dept 888078
Knoxville, TN 37995

140 Vista Centre Dr
Fl 2
Forest, VA 24551
Phone (434) 200-2297

1701 Thomson Dr
Ste 200
Lynchburg, VA 24501
Phone (434) 200-5925

1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101

Interoperability endpoints

  • Direct secure messaging: susannah.cooper@aoa.ikm.direct-ci.com

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1790846038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910221",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753910221",
            "telephone_number": "520-519-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 W SAINT MARYS RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857452624",
            "telephone_number": "520-624-7445",
            "fax_number": "520-623-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "SUSANNAH",
        "middle_name": "CATHERINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "R5850",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "VA",
            "license": "0101242150",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AZ",
            "license": "62128",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TN",
            "license": "60670",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q055008",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.