NPIMap

Individual provider Active NPI

Mark Justin Cooper, MD

  • Emergency Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1912434127
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4351039245 Issued in MI
Practice address
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone
(269) 337-6600
Fax
(269) 337-6475
NPI assigned
May 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X E-13006 AR
Student in an Organized Health Care Education/Training Program 390200000X 4351039245 MI
Emergency Medicine Physician 207P00000X 4351039245 MI Primary

Addresses

Primary practice location

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Mailing address

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20200409002246 AR Practitioner - Emergency Medicine 7618245424 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Texas Southwestern Medical School at Dallas, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flagg Emergency Group, PLLCGroup PAC ID 5698008019, 11 clinicians
Faulkner Emergency Group, PLLCGroup PAC ID 1557694049, 19 clinicians

Practice addresses (Care Compare)

200 N 3Rd St
Dardanelle, AR 72834-3802
Phone (479) 229-4677

2302 College Ave
Conway, AR 72034-6297
Phone (501) 329-3831

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-13006ARMDEmergency Medicine Physician
4351039245MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest City Emergency Physicians, PLLC Emergency Medicine CurrentSince Nov 6, 2022 Accepting new patients
Faulkner Emergency Group, PLLC Emergency Medicine CurrentSince May 3, 2020 Accepting new patients
Shiloh Emergency Group PLLC Emergency Medicine CurrentSince Oct 20, 2020 Accepting new patients
St. Vincent Infirmary Medical Center Current Accepting new patients
Flagg Emergency Group, PLLC Emergency Medicine CurrentSince Jul 7, 2020 Accepting new patients
Forrest City Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 6, 2022 Accepting new patients

Locations

2302 College Ave
Conway, AR 72034
Phone (501) 329-3831

200 N 3rd St
Dardanelle, AR 72834
Phone (479) 229-2827

1601 New Castle Rd
Forrest City, AR 72335
Phone (870) 261-0000

10100 Kanis Rd
Little Rock, AR 72205
Phone (501) 255-6000

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

4 Hospital Dr
Morrilton, AR 72110
Phone (501) 977-2300

2215 Wildwood Ave
Sherwood, AR 72120
Phone (501) 522-7100

Organizations & group practices 6

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 7

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": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1912434127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6600",
            "fax_number": "269-337-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-6600",
            "fax_number": "269-337-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MARK",
        "middle_name": "JUSTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-18",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AR",
            "license": "E-13006",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351039245",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4351039245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.