Active NPI
Harold Groves Cooke III, DDS
- Endodontics
- Washington, MO
National Provider Identifier
1851666754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 011523
- Practice address
- 709 Jefferson St
Washington, MO 63090-2709 - Phone
- (636) 239-2316
- Fax
- (636) 239-2316
- NPI assigned
- Mar 12, 2012
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 011523 | MO | Primary |
Addresses
Primary practice location
709 Jefferson St
Washington, MO 63090-2709
Mailing address
709 Jefferson St
Washington, MO 63090-2709
Phone (636) 239-2316
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140609000511 | MO | Order and Referring Only - Oral Surgery | 8729202098 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011523 | MO | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331510400000",
"number": "1851666754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 JEFFERSON ST",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630902709",
"telephone_number": "636-239-2316",
"fax_number": "636-239-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 JEFFERSON ST",
"city": "WASHINGTON",
"state": "MO",
"postal_code": "630902709",
"telephone_number": "636-239-2316",
"fax_number": "636-239-2316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOKE",
"first_name": "HAROLD",
"middle_name": "GROVES",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-12",
"last_updated": "2012-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MO",
"license": "011523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; 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.