JERALD L COOPER (NPI# 1598768566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598768566 |
| Entity Type | Individual |
| Full Name | JERALD L COOPER |
| Credential | M.D. |
| Practice Address |
7601 W Jefferson Blvd Fort Wayne IN 46804-4133 |
| Mailing Address |
Po Box 2526 Fort Wayne IN 46801-2526 |
| Practice Telephone | 2604368686 |
| Practice Fax Number | 2604368585 |
| Mailing Telephone | 2604368686 |
| Mailing Fax Number | 2604368585 |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
01041661A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | 200015791 | 01 | |
| ANTHEM | 00000089395 | 01 | |
| IN | 100340100A | 05 |
| Street Address |
7601 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497758429 | Fort Wayne Orthopaedics LLC | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2005-05-23 |
| 1801456553 | Elizabeth Schaefer | Specialist/Technologist | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-06-15 |
| 1417514480 | Courtney Mangan | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-05-24 |
| 1881177798 | Lindsey M. Hertenstein | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-09-07 |
| 1912407099 | Heather Korte | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-02-15 |
| 1902314958 | John Grimshaw | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-01-11 |
| 1053836882 | Alex Villavicencio | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-08-14 |
| 1841721735 | Abbey K. Bunnell | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-23 |
| 1093256950 | Jessica A. Wiedemann | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-13 |
| 1245786672 | Abigail Vanlaningham | Physician Assistant | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2016-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235404526 | Eric Philip Tannenbaum | Orthopaedic Surgery | 940 N Marr Rd Ste C, Columbus, IN 47201 | 2012-03-20 |
| 1326213109 | Steven K Ahlfeld Md, PC | Orthopaedic Surgery | 9302 N Meridian St Ste 110, Indianapolis, IN 46260-1818 | 2008-04-23 |
| 1780707265 | New Hope Orthopaedics and Sports Medicine PC | Orthopaedic Surgery | 325 Westfield Rd, Suite A, Noblesville, IN 46060-1497 | 2007-04-09 |
| 1740313071 | Atlas Orthopedics & Sports Medicine Inc PC | Orthopaedic Surgery | 3660 Guion Rd Ste 230, Indianapolis, IN 46222-1691 | 2007-03-14 |
| 1780723122 | Jeffrey S Staron | Orthopaedic Surgery | 8141 Calumet Ave Unit 1, Munster, IN 46321-1701 | 2007-02-05 |
| 1376622936 | Lorin Merrill Brown | Orthopaedic Surgery | 1950 45th St Ste 200, Munster, IN 46321-3958 | 2006-11-03 |
| 1033214366 | Rivercross Orthopaedics & Sports Medicine PC | Orthopaedic Surgery | 18051 River Ave Ste 100, Noblesville, IN 46062-7093 | 2006-09-13 |
| 1366489338 | Dale S Snead | Orthopaedic Surgery | 201 Pennsylvania Parkway Suite 200, Indianapolis, IN 46280-2301 | 2006-05-31 |
| 1407859051 | Daniel C Eby | Orthopaedic Surgery | 600 W. 13th St, Suite 200, Jasper, IN 47546-1883 | 2005-05-27 |
| 1639782907 | Jenna Renee Sparks | Orthopaedic Surgery | 1801 N Senate Blvd Ste 400, Indianapolis, IN 46202-1245 | 2020-08-26 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.