Individual provider Active NPI

Cory Mical Edgar, PA-C

  • Medical Physician Assistant
  • Orlando, FL
National Provider Identifier
1316336076
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9109621 Issued in FL
Practice address
2415 N Orange Ave Ste 601
Orlando, FL 32804-5558
Phone
(407) 303-2070
Fax
(407) 303-2071
NPI assigned
Jan 20, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X TX
Physician Assistant 363A00000X PA09629 TX
Medical Physician Assistant 363AM0700X PA9109621 FL Primary

Addresses

Primary practice location

2415 N Orange Ave Ste 601
Orlando, FL 32804-5558

Mailing address

2415 N Orange Ave Ste 601
Orlando, FL 32804-5558
Phone (407) 303-2070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161102002696 FL Practitioner - Physician Assistant 0547585234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2415 N Orange Ave
Orlando, FL 32804-5505

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
TEMPORARYTXMDHematology & Oncology Physician
PA09629TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Sep 6, 2016 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Sep 6, 2016 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

2415 N Orange Ave
Ste 601
Orlando, FL 32804
Phone (407) 303-2070

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: cedgar70596@adventhealth.direct-ci.com

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": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1316336076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 N ORANGE AVE STE 601",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045558",
            "telephone_number": "407-303-2070",
            "fax_number": "407-303-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 N ORANGE AVE STE 601",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045558",
            "telephone_number": "407-303-2070",
            "fax_number": "407-303-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGAR",
        "first_name": "CORY",
        "middle_name": "MICAL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-20",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09629",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9109621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.