Physician Compare National (NPI:1942383393)

HEALTHCARE PROVIDER: WANTZY COOPER D.O.

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

Individual Professional Information
NPI	1942383393
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002815214
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110208000789
	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	WANTZY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	VASCULAR SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	UNDERSEA AND HYPERBARIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	UNDERSEA AND HYPERBARIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1520 E HAMMER LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 105
	Group Practice or individual's line 2 address
City	FORT MOHAVE
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	864266665
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	051323
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COLORADO RIVER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050038
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SANTA CLARA VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y