Individual provider Active NPI

Jacob Gregory Cooley, DNP, CRNA

  • Certified Registered Nurse Anesthetist
  • Boston, MA
National Provider Identifier
1821528969
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
10264 Issued in WI
Practice address
1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone
(617) 638-6950
Fax
(617) 638-6966
NPI assigned
Jun 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 10264 WI Primary
Certified Registered Nurse Anesthetist 367500000X RN697361 PA

Addresses

Primary practice location

1 Boston Medical Ctr PL
Boston, MA 02118-2908

Mailing address

3066 N Station St
Verona, WI 53593-8722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, WA, OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210715000758 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517238306 Reassigns benefits to 1 organization
I20220112001711 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517238306 Reassigns benefits to 1 organization
I20250915000861 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517238306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

417 Fairview Ave
Ponca City, OK 74601-1923
Phone (580) 762-3770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN697361PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Stillwater Medical Center Authority Anesthesiology CurrentSince Aug 1, 2025 Accepting new patients
Stillwater Medical Center Authority CurrentSince Aug 1, 2025 Accepting new patients
Anesthesia Associates of New Mexico P C CurrentSince Jul 1, 2021 Accepting new patients
Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC Anesthesiology CurrentSince Jan 3, 2022 Accepting new patients

Locations

2655 Northwinds Pkwy
Alpharetta, GA 30009
Phone (678) 690-7804

8300 Constitution Ave NE
Albuquerque, NM 87110
Phone (505) 291-2000

1100 Central Ave SE
Albuquerque, NM 87106
Phone (505) 724-6124

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1821528969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3066 N STATION ST",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535938722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-638-6950",
            "fax_number": "617-638-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "JACOB",
        "middle_name": "GREGORY",
        "credential": "DNP, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "10264",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN697361",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.