Individual provider Active NPI

Adam Wallace Cordum, MD

  • Family Medicine Physician
  • Raleigh, NC
National Provider Identifier
1053940049
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024-01645 Issued in NC
Practice address
8300 Health Park Ste 107
Raleigh, NC 27615-4731
Phone
(919) 238-2000
Fax
(919) 238-5010
NPI assigned
Apr 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 2024-01645 NC
Family Medicine Physician 207Q00000X 2024-01645 NC Primary

Addresses

Primary practice location

8300 Health Park Ste 107
Raleigh, NC 27615-4731

Mailing address

PO Box 604337
Charlotte, NC 28260-4337
Phone (919) 238-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250219000930 NC Practitioner - Family PracticePractitioner - Sports Medicine 8325460058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of Oklahoma College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Novant Health Triangle Medical Group LLCGroup PAC ID 3476081985, 18 clinicians

Practice addresses (Care Compare)

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

8300 Health Park
Suite 107
Raleigh, NC 27615-4731
Phone (919) 238-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8700WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Triangle Medical Group, LLC Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
Novant Health Triangle Medical Group, LLC CurrentSince Jan 1, 2025 Accepting new patients

Locations

3700 NW Cary Pkwy
Ste 110
Cary, NC 27513
Phone (919) 319-3649

1070 S Main St
Ste 130
Holly Springs, NC 27540

8300 Health Park
Ste 107
Raleigh, NC 27615
Phone (919) 846-7312

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1053940049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604337",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604337",
            "telephone_number": "919-238-2000",
            "fax_number": "919-238-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 HEALTH PARK STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154731",
            "telephone_number": "919-238-2000",
            "fax_number": "919-238-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDUM",
        "first_name": "ADAM",
        "middle_name": "WALLACE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2025-01-02",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NC",
            "license": "2024-01645",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2024-01645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.