NPIMap

Organization Active NPI

A&E Medical Group-a Professional Nursing Corporation

Doing business as Cordial Healthcare Providers

  • Family Nurse Practitioner
  • Glendale, CA
National Provider Identifier
1306424502
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
A&E MEDICAL GROUP-A PROFESSIONAL NURSING CORPORATION
Doing business as
Cordial Healthcare Providers
Practice address
127 S Brand Blvd Ste 333
Glendale, CA 91204-1390
Phone
(747) 238-2544
NPI assigned
Mar 30, 2021
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Mr. Derick Que
Title
Manager
Phone
(747) 238-2544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

127 S Brand Blvd Ste 333
Glendale, CA 91204-1390

Mailing address

127 S Brand Blvd Ste 333
Glendale, CA 91204-1390
Phone (747) 238-2544

Other names 1

  • Cordial Healthcare Providers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210622001252 CA Part B Supplier - Clinic/Group Practice 7719388230 Receives reassigned benefits from 33 practitioners
Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Locations

121 W Lexington Dr
Ste 726
Glendale, CA 91203
Phone (818) 239-9293

127 S Brand Blvd
Ste 333
Glendale, CA 91204
Phone (747) 238-2544

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1306424502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S BRAND BLVD STE 333",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041390",
            "telephone_number": "747-238-2544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S BRAND BLVD STE 333",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041390",
            "telephone_number": "747-238-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A&E MEDICAL GROUP-A PROFESSIONAL NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "QUE",
        "authorized_official_first_name": "DERICK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "747-238-2544",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cordial Healthcare Providers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.