Physician Compare National (NPI:1588094130)

HEALTHCARE PROVIDER: SHARRELL COOPER M.D

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1588094130
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941439095
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150731015883
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COOPER
	Individual professional last name
Provider First Name	SHARRELL
	Individual professional first name
Provider Middle Name	N
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MEMORIAL HOSPITAL FLAGLER INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1759371594
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	45
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	120 CYPRESS EDGE DR
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	PALM COAST
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	321648454
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100118
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FLORIDA HOSPITAL FLAGLER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FLORIDA HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100068
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y