Individual provider Active NPI

Mercedes Alexis Cook, D.C.

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1922504745
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
34707 Issued in CA
Practice address
409 Camino del Rio S Ste 105
San Diego, CA 92108-3505
Phone
(858) 622-0662
NPI assigned
Apr 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC-04803 OH
Chiropractor 111N00000X 34707 CA Primary

Addresses

Primary practice location

409 Camino del Rio S Ste 105
San Diego, CA 92108-3505

Mailing address

409 Camino del Rio S
Ste 105
San Diego, CA 92108-3505
Phone (858) 577-0662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200922000545 CA Practitioner - Chiropractic 6507129848 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

409 Camino del Rio S
Suite 105
San Diego, CA 92108-3505
Phone (858) 577-0662

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34707CAMDLicensed Psychiatric Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Upper Cervical Chiropractic, Apc CurrentSince Jun 17, 2020 Accepting new patients
Jessica Lee Chiropractic. Inc Chiropractor CurrentSince Mar 1, 2020 Accepting new patients

Locations

409 Camino del Rio S
Ste 105
San Diego, CA 92108
Phone (858) 434-5926

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1922504745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 CAMINO DEL RIO S",
            "address_2": "STE 105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083505",
            "telephone_number": "858-577-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 CAMINO DEL RIO S STE 105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083505",
            "telephone_number": "858-622-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "MERCEDES",
        "middle_name": "ALEXIS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "DC-04803",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.