NPIMap

Individual provider Active NPI

Jeniece Alison Cooper, MD

  • Family Medicine Physician
  • Williamsport, PA
National Provider Identifier
1861015596
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD481730 Issued in PA
Practice address
145 Shaffer St
Williamsport, PA 17702-6727
Phone
(570) 327-1335
Fax
(570) 321-7800
NPI assigned
May 28, 2020
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD481730 PA Primary

Addresses

Primary practice location

145 Shaffer St
Williamsport, PA 17702-6727

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other names 1

  • Jeniece Alison Goshorn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230731000145 PA Practitioner - Family Practice 4880055490 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Center PCGroup PAC ID 0244124212, 351 clinicians
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians

Practice addresses (Care Compare)

145 Shaffer St
Williamsport, PA 17702-6727
Phone (570) 327-1335

740 High St
Suite 4001
Williamsport, PA 17701-3111
Phone (570) 321-2345

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions20
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD481730PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC CurrentSince Jul 11, 2023 Accepting new patients
Susquehanna Physician Services CurrentSince Nov 9, 2023 Accepting new patients
Family Practice Center, PC Multi-Specialty CurrentSince Jul 11, 2023 Accepting new patients
Susquehanna Physician Services Multi-Specialty CurrentSince Nov 9, 2023 Accepting new patients

Locations

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

270 Susquehanna Valley Mall Dr
Ste 300
Selinsgrove, PA 17870
Phone (570) 743-1703

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

1205 River Ave
#1
Williamsport, PA 17701
Phone (570) 323-5991

145 Shaffer St
Williamsport, PA 17702
Phone (570) 326-2447

700 High St
Williamsport, PA 17701
Phone (570) 321-2000

700 High St
Ste 4001
Williamsport, PA 17701

740 High St
Ste 4001
Williamsport, PA 17701
Phone (570) 321-2345

Interoperability endpoints

  • Direct secure messaging: jeniececoopermd@fpc.medentdirect.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 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1861015596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 SHAFFER ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177026727",
            "telephone_number": "570-327-1335",
            "fax_number": "570-321-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "JENIECE",
        "middle_name": "ALISON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-28",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD481730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENIECE",
            "last_name": "GOSHORN",
            "middle_name": "ALISON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.