Clive R Cooper, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

M6445 Issued in ID

Practice address

600 N Robbins Rd
Boise, ID 83702-4565

Phone

(208) 385-3329

Fax

(208) 489-4063

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ccooper26355@direct.slhs.org

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  Internal Medicine

  NPD
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  NPD (past)
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1962446104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 N 11TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-367-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N ROBBINS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024565",
            "telephone_number": "208-385-3329",
            "fax_number": "208-489-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "CLIVE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "ID",
            "license": "M6445",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M6445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003624900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanness Lynn Coonrod, SLP1695
• Kendra Coonse, M.D.
• Abigail Elizabeth Cooper, LPC
• Amy L. Cooper, MD
• Candace Cooper, LPC
• Hayden Cooper
• Jonah Cooper
• Lauren Marissa Cooper, MD
• Lynzi Cooper
• Robert M Cooper, MD

• Internal Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Internal Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; 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.