Wantzy Cooper, D.O.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

005530 Issued in AZ

Practice address

1401 Bailey Ave
BLDG 1
Needles, CA 92363-3103

Phone

(760) 590-0155

Fax

(760) 323-7134

NPI assigned

Oct 21, 2006

Last updated

Apr 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Vascular SurgeryAlso: Emergency Medicine, Family Practice, General Practice, Interventional Pain Management

Education

College of Osteo Med of the Pacific at Pomona, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Healthcare Partner, IncGroup PAC ID 5698912095, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Billet Hospice Inc- Bullhead City Hospice, Bullhead City, AZ, CCN 031650
• Colorado River Medical Center Hospital, Needles, CA, CCN 051323

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Community Healthcare Partner, Inc

  dba Colorado River Medical Center

  • Critical Access Hospital
  • Needles, CA
  • NPI 1457520942
  Medicare reassignment Care Compare group NPD
• Tri-State Vascular Group, PLLC

  • Vascular Surgery Physician
  • Needles, CA
  • NPI 1366993818

  AZ

  Medicare reassignment NPD Authorized official
• Colorado River Primary Care, Inc

  dba Tri State Primary Care

  • Internal Medicine Physician
  • Fort Mohave, AZ
  • NPI 1669146536
  Medicare reassignment Authorized official
• Wantzy Cooper Enterprises LLC

  • Clinic/Center
  • Bullhead City, AZ
  • NPI 1730931718
  NPD Authorized official
• Community Healthcare Partner, Inc

  dba Colorado River Medical Center

  • Diagnostic Radiology Physician
  • Needles, CA
  • NPI 1336526086
  NPD
• Link Medical Inc

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1073031357
  NPD (past)

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

• Community Healthcare Partner, Inc

  dba Colorado River Medical Center

  • Critical Access Hospital
  • Needles, CA
  • NPI 1457520942
  Care Compare affiliation
• Billet Hospice Inc - Bullhead City

  • Community Based Hospice Care Agency
  • Bullhead City, AZ
  • NPI 1669990941
  Care Compare affiliation

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1942383393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9893",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864279893",
            "telephone_number": "760-590-0155",
            "fax_number": "760-323-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 BAILEY AVE",
            "address_2": "BLDG 1",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633103",
            "telephone_number": "760-590-0155",
            "fax_number": "760-323-7134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "WANTZY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-21",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "14611",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "MB74255",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "14611",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "005530",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "14611",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "005530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585877",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Community Healthcare Partner, Inc (Colorado River Medical Center)
• Community Healthcare Partner, Inc (Colorado River Medical Center)
• Community Healthcare Partner, Inc. (Colorado River Medical Center)
• Community Healthcare Partner, Inc. (Colorado River Medical Center)
• Community Healthcare Partner, Inc. (Colorado River Medical Center)
• County of San Bernardino (Needles Clinic)
• County of San Bernardino
• Kristi Evans
• Mariah Funderburg, LMFT
• Sonia Gallegos, MSW

• Vascular Surgery Physician in Needles, CA
• Providers in Needles, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.
• 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.