Richard Edward Cooksley, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00272 Issued in OR

Practice address

115 S Pine St
Canyonville, OR 97417-9648

Phone

(541) 839-4211

Fax

(541) 839-4983

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Dr Anna LLC

  • Internal Medicine Physician
  • Canyonville, OR
  • NPI 1003210600

  OR

  Medicare reassignment
• Falk Family Medicine, LLC

  • Family Medicine Physician
  • Canyonville, OR
  • NPI 1255521225
  NPD (past)
• Mark M Herscher DO

  • Family Medicine Physician
  • Myrtle Creek, OR
  • NPI 1316125784
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1942271192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974170888",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S PINE ST",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "974179648",
            "telephone_number": "541-839-4211",
            "fax_number": "541-839-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOKSLEY",
        "first_name": "RICHARD",
        "middle_name": "EDWARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930087876",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA00272",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165878",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bonita Acosta, FNP
• Shari Lavida Allen, FNP
• Robert Bakkegard, RPH
• Canyonville Chiropractic Inc
• Cow Creek Band of Umpqua Tribe of Indians
• Cow Creek Health & Wellness Annex
• Donato and Wood Consulting Inc
• Donato and Wood Consulting, Inc
• Dr Anna LLC

• All providers in Canyonville, OR
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; 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.