Active NPI 1942207634 Individual Practitioner Male Practitioner

Dr. Richard Cooper , MD

Internal Medicine • Canton, OH

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Richard Cooper, MD is a certified Internal Medicine practicing in Canton, OH. With approximately 42 years of clinical experience since completing medical education in 1984, Dr. Cooper delivers high-quality medical care to the local community at 2425 13TH ST NW.

Dr. Cooper accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, follow-up hospital inpatient care per day, annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2425 13th St Nw

Canton, OH 447083116

Telephone 3304555595

Associated Practice Facility / Clinic

🏢 Astute Medical Associates Inc Facility NPI 1215984604

Medicare Profile & Education

Medical School

Other

Graduation Year

1984

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Canton, OH

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

42 Yrs +21.5 yrs vs City Avg

City Avg: 20.5 Yrs

State Avg: 26.9 Yrs

Regional Practice Density

124 Specialists

Practicing in Canton, OH (5516 Statewide)

Telehealth Adoption Rate

13.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

11.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Cooper (42 Years) 42 Yrs

Canton Specialty Average (20.5 Years) 20.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	355	218	$95.00	$84.96
99231 Follow-up hospital inpatient care per day, typically 15 minutes	225	102	$50.00	$45.59
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	198	198	$135.00	$120.76
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	127	123	$245.00	$158.69
G0008 Administration of influenza virus vaccine	122	122	$35.00	$30.14
90662 Influenza vaccine split virus, preservative free	122	122	$85.00	$81.15
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	92	48	$87.00	$74.62
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	90	40	$25.00	$21.48
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	89	69	$60.00	$50.72
99238 Hospital discharge day management, 30 minutes or less	34	26	$80.00	$75.15
99496 Transitional care management services for problem of high complexity	31	25	$275.00	$261.14
36415 Insertion of needle into vein for collection of blood sample	23	20	$7.00	$6.86
G0009 Administration of pneumococcal vaccine	19	19	$30.00	$29.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	16	16	$130.00	$121.04
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	14	14	$300.00	$290.77
81002 Urinalysis, manual test	13	12	$8.00	$3.41
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	12	12	$175.00	$155.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	355	222	$95.00	$87.03
99231 Follow-up hospital inpatient care per day, typically 15 minutes	235	98	$50.00	$49.04
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	211	211	$135.00	$124.20
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	128	122	$245.00	$170.69
G0008 Administration of influenza virus vaccine	120	120	$35.00	$28.87
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	120	62	$87.00	$77.84
90662 Influenza vaccine split virus, preservative free	117	117	$75.00	$70.09
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	82	38	$25.00	$21.95
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	76	59	$60.00	$53.70
99496 Transitional care management services for problem of high complexity	39	29	$275.00	$266.91
81002 Urinalysis, manual test	35	26	$8.00	$3.41
99238 Hospital discharge day management, 30 minutes or less	27	21	$79.56	$78.76
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	23	$130.00	$123.81
36415 Insertion of needle into vein for collection of blood sample	20	20	$7.00	$6.86
G0009 Administration of pneumococcal vaccine	19	19	$30.00	$29.36
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	14	14	$175.00	$161.20
93000 Routine ekg using at least 12 leads including interpretation and report	13	12	$58.00	$13.92
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	13	13	$298.85	$282.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	410	245	$95.00	$87.55
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	231	231	$135.00	$124.07
99231 Follow-up hospital inpatient care per day, typically 15 minutes	161	77	$50.00	$36.91
G0008 Administration of influenza virus vaccine	111	111	$30.00	$27.45
90662 Influenza vaccine split virus, preservative free	107	107	$70.00	$67.26
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	84	49	$87.00	$67.51
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	75	70	$245.00	$187.56
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	67	44	$25.00	$21.88
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	52	40	$60.00	$54.16
99220 Hospital observation care, typically 70 minutes	50	50	$200.00	$173.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	41	30	$60.00	$35.68
99453 Remote monitoring of physiologic parameters, initial set-up and patient education on use of equipment	36	11	$20.00	$17.24
99454 Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days	35	11	$52.00	$50.34
99457 Management using the results of remote vital sign monitoring per calendar month, first 20 minutes	33	11	$50.00	$47.38
99496 Transitional care management services for problem of high complexity	33	31	$275.00	$267.44
99238 Hospital discharge day management, 30 minutes or less	31	27	$76.00	$67.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	29	26	$130.00	$123.81
G0009 Administration of pneumococcal vaccine	28	28	$28.04	$26.77
82044 Urine microalbumin (protein) analysis	21	18	$11.00	$6.16
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	15	15	$138.00	$131.44
36415 Insertion of needle into vein for collection of blood sample	15	13	$7.00	$2.96
99213 Established patient office or other outpatient visit, typically 15 minutes	14	11	$95.00	$65.73
81002 Urinalysis, manual test	14	13	$8.00	$3.44
90670 Pneumococcal vaccine for injection into muscle	13	13	$258.46	$251.74
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$175.91	$163.67
93000 Routine ekg using at least 12 leads including interpretation and report	11	11	$58.00	$13.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,140	12	$21.03	$19.93
99213 Established patient office or other outpatient visit, typically 15 minutes	413	257	$94.39	$89.30
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	232	232	$135.00	$128.29
99231 Follow-up hospital inpatient care per day, typically 15 minutes	165	69	$50.00	$35.44
G0008 Administration of influenza virus vaccine	123	121	$25.00	$15.79
90662 Influenza vaccine split virus, preservative free	120	118	$69.78	$63.52
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	73	41	$25.00	$21.81
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	67	33	$87.00	$67.11
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	59	49	$59.19	$54.60
G0442 Annual alcohol misuse screening, 5 to 15 minutes	56	56	$20.00	$17.75
G0444 Annual depression screening, 5 to 15 minutes	54	54	$20.00	$17.74
99220 Hospital observation care, typically 70 minutes	52	51	$200.00	$176.89
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	49	35	$59.67	$34.94
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	46	44	$245.00	$194.14
81002 Urinalysis, manual test	28	24	$8.00	$3.48
99496 Transitional care management services for problem of high complexity	28	23	$275.00	$273.20
36415 Insertion of needle into vein for collection of blood sample	24	22	$7.00	$3.00
99238 Hospital discharge day management, 30 minutes or less	24	21	$76.00	$71.22
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	19	12	$25.00	$13.80
G0009 Administration of pneumococcal vaccine	17	17	$25.00	$15.22
82044 Urine microalbumin (protein) analysis	16	15	$11.00	$6.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	15	15	$123.47	$122.70
99213 Established patient office or other outpatient visit, typically 15 minutes	15	14	$95.00	$67.48
93000 Routine ekg using at least 12 leads including interpretation and report	13	13	$58.00	$14.48
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	13	13	$180.00	$152.98
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	12	12	$125.83	$123.44

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,141	13	$20.68	$19.00
99213 Established patient office or other outpatient visit, typically 15 minutes	422	263	$86.00	$72.78
G0442 Annual alcohol misuse screening, 5 to 15 minutes	267	267	$20.00	$17.28
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	245	245	$135.00	$112.93
G0444 Annual depression screening, 5 to 15 minutes	238	238	$20.00	$17.54
99231 Follow-up hospital inpatient care per day, typically 15 minutes	227	77	$50.00	$39.11
G0008 Administration of influenza virus vaccine	129	129	$25.00	$15.57
90662 Influenza vaccine split virus, preservative free	128	128	$61.00	$59.07
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	85	65	$52.00	$43.21
99220 Hospital observation care, typically 70 minutes	64	63	$200.00	$186.25
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	61	43	$25.00	$22.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	60	45	$52.00	$26.10
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	58	55	$245.00	$196.66
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	42	25	$87.00	$69.25
99496 Transitional care management services for problem of high complexity	25	23	$275.00	$239.11
82044 Urine microalbumin (protein) analysis	24	23	$11.00	$6.19
G0009 Administration of pneumococcal vaccine	22	22	$25.00	$15.97
99238 Hospital discharge day management, 30 minutes or less	21	19	$76.00	$69.42
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	20	13	$25.00	$13.92
36415 Insertion of needle into vein for collection of blood sample	19	18	$7.00	$2.67
81002 Urinalysis, manual test	18	16	$8.00	$3.46
93000 Routine ekg using at least 12 leads including interpretation and report	15	11	$58.00	$16.59
90670 Pneumococcal vaccine for injection into muscle	14	14	$227.50	$221.99
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	12	12	$175.00	$164.48
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	11	11	$180.00	$168.74

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,380	12	$19.09	$18.62
99213 Established patient office or other outpatient visit, typically 15 minutes	486	298	$86.00	$71.00
99231 Follow-up hospital inpatient care per day, typically 15 minutes	402	154	$50.00	$38.54
G0442 Annual alcohol misuse screening, 5 to 15 minutes	289	289	$20.00	$16.91
G0444 Annual depression screening, 5 to 15 minutes	281	281	$20.00	$17.09
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	274	274	$135.00	$110.99
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	149	137	$245.00	$198.16
G0008 Administration of influenza virus vaccine	112	112	$25.00	$15.61
90662 Influenza vaccine split virus, preservative free	109	109	$57.00	$54.39
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	108	65	$25.00	$21.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	100	75	$52.00	$42.94
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	93	51	$87.00	$70.35
99220 Hospital observation care, typically 70 minutes	57	57	$200.00	$180.15
99238 Hospital discharge day management, 30 minutes or less	53	44	$76.00	$71.72
36415 Insertion of needle into vein for collection of blood sample	51	41	$7.00	$2.94
99496 Transitional care management services for problem of high complexity	47	36	$275.00	$223.67
82044 Urine microalbumin (protein) analysis	41	41	$11.00	$6.11
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	39	35	$52.00	$25.19
G0009 Administration of pneumococcal vaccine	37	37	$25.00	$15.32
93000 Routine ekg using at least 12 leads including interpretation and report	33	26	$58.00	$16.32
81002 Urinalysis, manual test	27	26	$8.00	$3.41
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	23	12	$25.00	$15.96
90670 Pneumococcal vaccine for injection into muscle	22	22	$214.09	$196.84
99495 Transitional care management services for problem of at least moderate complexity	21	20	$190.00	$150.87
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	17	17	$175.00	$155.30
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$165.00	$127.40
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	15	15	$110.00	$107.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,200	12	$17.82	$17.53
99213 Established patient office or other outpatient visit, typically 15 minutes	598	320	$76.68	$69.91
99231 Follow-up hospital inpatient care per day, typically 15 minutes	368	142	$50.00	$37.98
G0442 Annual alcohol misuse screening, 5 to 15 minutes	304	304	$19.59	$17.16
G0444 Annual depression screening, 5 to 15 minutes	298	298	$19.60	$16.89
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	290	290	$135.00	$110.23
G0008 Administration of influenza virus vaccine	162	162	$25.00	$19.30
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	161	150	$215.65	$193.14
90662 Influenza vaccine split virus, preservative free	160	160	$55.00	$52.30
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	135	65	$25.00	$20.46
85610 Blood test, clotting time	120	12	$9.00	$4.75
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	91	72	$50.48	$41.94
G0009 Administration of pneumococcal vaccine	85	85	$25.00	$18.62
82044 Urine microalbumin (protein) analysis	74	71	$11.00	$6.11
99496 Transitional care management services for problem of high complexity	60	44	$241.67	$223.09
99238 Hospital discharge day management, 30 minutes or less	54	40	$76.00	$70.26
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	51	37	$76.65	$70.18
36415 Insertion of needle into vein for collection of blood sample	50	41	$7.00	$2.88
81002 Urinalysis, manual test	50	41	$8.00	$3.41
90670 Pneumococcal vaccine for injection into muscle	44	44	$206.59	$193.94
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	41	41	$108.05	$98.96
82270 Stool analysis for blood to screen for colon tumors	27	27	$5.00	$4.13
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	21	21	$175.00	$150.05
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	20	12	$25.00	$19.39
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	19	17	$51.26	$23.61
93000 Routine ekg using at least 12 leads including interpretation and report	18	17	$58.00	$15.29
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$165.00	$126.72
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$165.00	$154.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$106.00	$95.97

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,260	13	$16.81	$16.51
99213 Established patient office or other outpatient visit, typically 15 minutes	593	324	$72.00	$70.06
99231 Follow-up hospital inpatient care per day, typically 15 minutes	436	209	$50.00	$37.92
G0442 Annual alcohol misuse screening, 5 to 15 minutes	323	323	$18.00	$16.80
G0444 Annual depression screening, 5 to 15 minutes	317	317	$18.00	$16.85
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	311	311	$135.00	$109.80
85610 Blood test, clotting time	195	17	$9.00	$5.28
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	192	183	$210.00	$195.79
G0008 Administration of influenza virus vaccine	187	187	$25.00	$23.51
90662 Influenza vaccine split virus, preservative free	177	177	$50.60	$47.26
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	106	83	$50.00	$41.52
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	93	59	$75.00	$70.43
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	78	42	$25.00	$19.10
82044 Urine microalbumin (protein) analysis	73	71	$11.00	$6.15
36415 Insertion of needle into vein for collection of blood sample	73	59	$7.00	$2.94
81002 Urinalysis, manual test	53	40	$8.00	$3.17
G0009 Administration of pneumococcal vaccine	53	53	$25.00	$23.76
99496 Transitional care management services for problem of high complexity	48	41	$235.00	$216.53
99238 Hospital discharge day management, 30 minutes or less	40	32	$76.00	$70.40
90670 Pneumococcal vaccine for injection into muscle	37	37	$191.76	$185.53
82270 Stool analysis for blood to screen for colon tumors	36	36	$15.83	$4.26
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	21	13	$25.00	$23.88
93000 Routine ekg using at least 12 leads including interpretation and report	18	16	$58.00	$16.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	15	15	$106.00	$96.45
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	15	15	$97.33	$93.21
99495 Transitional care management services for problem of at least moderate complexity	14	14	$165.00	$156.06
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$165.00	$158.06
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	11	11	$175.00	$157.63

Medical Specialties & State Licenses

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License OH 35057528C

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active March 02, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location March 02, 2010

Registered at 2425 13TH ST NW, CANTON, OH 447083116 (Tel: 3304555595)

📍

Updated Business Mailing Address March 02, 2010

Registered at 2425 13TH ST NW, CANTON, OH 447083116 (Tel: 3304555595)

👤

Provider Name / Credentials Updated March 02, 2010

Recorded as RICHARD COOPER, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 02, 2010

Internal Medicine (License #35057528C in OH)

🟢

Initial NPI Registration & Enumeration July 07, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1942207634

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: July 07, 2005

Last Update: March 02, 2010

Sole Proprietor: No

Update or Correct Profile

Mailing Address

2425 13th St Nw

Canton, OH 447083116

Phone: 3304555595

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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