Jeril Ransom Cooper III, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8755 Issued in GA

Practice address

10621 Highway 11
Trenton, GA 30752-3026

Phone

(706) 657-7561

Fax

(706) 675-8124

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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.

• Red Rock Dental

  • Dental Clinic/Center
  • Trenton, GA
  • NPI 1447971262
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 18, 2007.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184716800000",
    "number": "1851333710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10621 HIGHWAY 11",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307523026",
            "telephone_number": "706-657-7561",
            "fax_number": "706-675-8124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10621 HIGHWAY 11",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307523026",
            "telephone_number": "706-657-7561",
            "fax_number": "706-675-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "JERIL",
        "middle_name": "RANSOM",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "8755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZG8755",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00139598B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00139598D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Center for Family Medicine
• Alexandra Chandler, DPT
• Anuj Chandra, M.D.
• David Anthony Collins, PT, DPT
• Complete Chiropractic Care, LLC
• Barbara Ann Cowan, LISW
• Felix D Cruz, LPC
• Dade County Board of Health
• Dade County Chiropractic Center LLC
• Dade County School System

• All providers in Trenton, GA
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.

Verify at the official NPI Registry.