Roger Cordial, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

102171 Issued in NC

Practice address

724 S Horner Blvd
Sanford, NC 27330-4822

Phone

(919) 776-6767

Fax

(919) 776-6773

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Sandhills Emergency Physicians PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • Pinehurst, NC
  • NPI 1003853409
  NPD (past)
• Sunshine City Emergency Physicians

  • Emergency Medicine Physician
  • St. Petersburg, FL
  • NPI 1770533143
  NPD (past)

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1063402006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 S HORNER BLVD",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304822",
            "telephone_number": "919-776-6767",
            "fax_number": "919-776-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 S HORNER BLVD",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304822",
            "telephone_number": "919-776-6767",
            "fax_number": "919-776-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDIAL",
        "first_name": "ROGER",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102837",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "102171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "34771",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKynzee Conley
• John Joseph Connors, LPC
• Contrasting Qualities, LLC
• Sabrina Schotte Cook, LCAS-A
• Nicole Marie Copersito, DPT
• Joshua Kentrell Cotten
• Shana Cotterman, PHARMD
• Counseling Connections Clinical Group, PLLC
• County of Lee
• County of Lee North Carolina

• All providers in Sanford, NC
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.