Individual provider Active NPI

Sophie Elizabeth Cooney, PA-C

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1821612391
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2023046479 Issued in MO
Practice address
621 S New Ballas Rd Ste 297a
Saint Louis, MO 63141-8200
Phone
(314) 251-6364
NPI assigned
Jun 1, 2020
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 028957 NY
Physician Assistant 363A00000X 10002971A IN
Physician Assistant 363A00000X 2023046479 MO Primary

Addresses

Primary practice location

621 S New Ballas Rd Ste 297a
Saint Louis, MO 63141-8200

Mailing address

621 S New Ballas Rd Ste 297a
Saint Louis, MO 63141-8200
Phone (314) 251-6364

Other practice location 1

621 S New Ballas Rd Ste 298A
Saint Louis, MO 63141-8200
Phone (314) 251-6364

Other identifiers 1

IdentifierTypeStateIssuer
300040993MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240217000175 MO Practitioner - Physician Assistant 4284059429 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
Group practices
Mercy Clinic Surgical Specialists LLCGroup PAC ID 1153455076, 180 clinicians

Practice addresses (Care Compare)

621 S New Ballas Rd
Suite 298a
Saint Louis, MO 63141-8200
Phone (314) 251-6364

621 S New Ballas Rd
Suite 3005B
Saint Louis, MO 63141-8266
Phone (314) 567-5850

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
028957NYMDClinical Social Worker
10002971AINMDPhysician Assistant
2023046479MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nuvance Health Medical Practice PC CurrentSince Sep 26, 2022 Accepting new patients
Major Hospital Past Accepting new patients
Mercy Clinic East Communities Past Accepting new patients

Locations

45 Reade Pl
Fl 2
Poughkeepsie, NY 12601
Phone (845) 483-6001

Interoperability endpoints

  • Direct secure messaging: scooney515040@ecommunitydirect.com
  • Direct secure messaging: sophie.brown.1@7598.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1821612391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 297A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418200",
            "telephone_number": "314-251-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 297A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418200",
            "telephone_number": "314-251-6364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 S New Ballas Rd Ste 298A",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418200",
            "country_code": "US",
            "telephone_number": "314-251-6364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COONEY",
        "first_name": "SOPHIE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "028957",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002971A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2023046479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300040993",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.