Active NPI
Reese Jerel Cooper, DO
- General Practice Physician
- McClellan, CA
National Provider Identifier
1831691948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 3002
- Practice address
- 5342 Dudley Blvd BLDG 98
McClellan, CA 95652-1012 - Phone
- (916) 561-7793
- NPI assigned
- Mar 5, 2018
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 3002 | NE | Primary |
Addresses
Primary practice location
5342 Dudley Blvd BLDG 98
McClellan, CA 95652-1012
Mailing address
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone (618) 256-9355
Other practice location 1
101 Bodin Cir
Travis AFB, CA 94535-1809
Phone (707) 423-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250124002122 | NE | Order and Referring Only - Family Practice | 4981133675 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3002 | NE | MD | Physical Therapist |
| 7811204-2402 | UT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785110400000",
"number": "1831691948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 SAINT ELIZABETH BLVD STE 4000",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691284",
"telephone_number": "618-256-9355",
"fax_number": "618-206-2332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5342 DUDLEY BLVD BLDG 98",
"city": "MCCLELLAN",
"state": "CA",
"postal_code": "956521012",
"telephone_number": "916-561-7793"
}
],
"practiceLocations": [
{
"address_1": "101 Bodin Cir",
"address_purpose": "LOCATION",
"city": "Travis AFB",
"state": "CA",
"postal_code": "945351809",
"country_code": "US",
"telephone_number": "707-423-3000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COOPER",
"first_name": "REESE",
"middle_name": "JEREL",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-05",
"last_updated": "2026-07-27",
"certification_date": "2026-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NE",
"license": "3002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McClellan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.