Cory T Hall, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15806 Issued in CA

Practice address

1139 3Rd St
South Lake Tahoe, CA 96150-3465

Phone

(530) 541-3100

Fax

(530) 541-3016

NPI assigned

Nov 3, 2005

Last updated

Nov 16, 2007By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Presidio Surgery Center, LLC

  dba Presidio Surgery Center

  • Ambulatory Surgical Clinic/Center
  • San Francisco, CA
  • NPI 1609826361
  NPD

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1093706558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 529",
            "city": "ZEPHYR COVE",
            "state": "NV",
            "postal_code": "894480529",
            "telephone_number": "775-588-8938",
            "fax_number": "775-588-8930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 3RD ST",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503465",
            "telephone_number": "530-541-3100",
            "fax_number": "530-541-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "CORY",
        "middle_name": "T",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15806",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA678",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "CC1490",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Gutierrez
• Hyun Myung Ha, D.D.S.
• Michael E. R. Habicht, MD
• Angela Marie Hagenah, PTA
• Kenny D Halford
• Richard Keith Hall, DDS
• Dirk Starr Hamilton, DC
• Jeffrey Hanson, ND
• Grace Harding, D.O.
• April Marie Harvey, CADC - II

• Physician Assistant in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.