Kyle Gene Cooper, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

6069 Walkers LN
Eglin AFB, FL 32542-8505

Phone

(850) 882-1208

Fax

(850) 882-1194

NPI assigned

Oct 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crestview Urgent Care, Inc.Group PAC ID 3678614534, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Okaloosa Medical Center Hospital, Crestview, FL, CCN 100122

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Crestview Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Crestview, FL
  • NPI 1144458647
  Medicare reassignment Care Compare group
• Coastal Radiology Associates PA

  • Diagnostic Radiology Physician
  • Fort Walton Beach, FL
  • NPI 1750524393
  NPD (past)
• Emerald Coast Wellness Center, LLC

  • Adult Mental Health Clinic/Center
  • Niceville, FL
  • NPI 1417287855
  NPD (past)

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

• Crestview Hospital Company, LLC

  dba North Okaloosa Medical Center

  • General Acute Care Hospital
  • Crestview, FL
  • NPI 1104897859
  Care Compare affiliation

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982786380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 VIERVILLE CIR",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325428504",
            "telephone_number": "850-882-1170",
            "fax_number": "850-882-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6069 WALKERS LN",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325428505",
            "telephone_number": "850-882-1208",
            "fax_number": "850-882-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "KYLE",
        "middle_name": "GENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Taylor Colegrove
• Steven J. Colonna, MD
• Julia Elizabeth Comitalo, PHARMD
• Gavin Cone
• Alexandra Conway, MD
• Stacey Annette Cooper, CNM, ARNP
• Tamara Layne Copes, PT, DPT, MS, ATC
• Kent Alan Corso, PSYD
• Sean Francis Costello
• Joshua N Cragun, M.D.

• Physician Assistant in Eglin AFB, FL
• Providers in Eglin AFB, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.