NPIMap

Individual provider Active NPI

Rebecca Coker

  • Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1821608209
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1819 Carew St
Fort Wayne, IN 46805-4705
Phone
(405) 618-8499
NPI assigned
Jul 31, 2020
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X IN Primary

Addresses

Primary practice location

1819 Carew St
Fort Wayne, IN 46805-4705

Mailing address

1819 Carew St
Fort Wayne, IN 46805-4705

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL ...

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210616001392 CO Practitioner - Physician Assistant 9638579436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

750 Wellington Ave
Grand Junction, CO 81501-6132

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 9, 2022 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 9, 2022 Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

750 Wellington Ave
Ste 3A
Grand Junction, CO 81501
Phone (970) 248-3188

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

Organizations & group practices 5

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 5

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": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1821608209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 CAREW ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 CAREW ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054705",
            "telephone_number": "405-618-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COKER",
        "first_name": "REBECCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "...",
            "affiliation": "N",
            "address_1": "1819 Carew St",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468054705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.