Samuel Mauricio Cordova, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002213 Issued in IL

Practice address

1259 Rickert Dr Ste 101
Naperville, IL 60540-8904

Phone

(630) 355-1300

Fax

(630) 355-3273

NPI assigned

Oct 11, 2006

Last updated

Dec 13, 2012By 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 2

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034
• Community Hospital Hospital, Munster, IN, CCN 150125

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Community Care Network Inc

  dba Powers Health Medical Group

  • Family Medicine Physician
  • Saint John, IN
  • NPI 1457610487

  Physician Assistant

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munster Medical Research Foundation Inc

  dba Community Hospital

  • General Acute Care Hospital
  • Munster, IN
  • NPI 1003918210
  Care Compare affiliation
• St Mary Medical Center Inc

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1558463745
  Care Compare affiliation
• St Mary Medical Center Inc

  dba St Mary Wound Clinic

  • General Acute Care Hospital
  • Hobart, IN
  • NPI 1962504175
  Care Compare affiliation

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355356800000",
    "number": "1326137225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 COMMERCE CT",
            "address_2": "SUITE 230",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323698",
            "telephone_number": "630-968-1881",
            "fax_number": "630-968-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 RICKERT DR STE 101",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605408904",
            "telephone_number": "630-355-1300",
            "fax_number": "630-355-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "SAMUEL",
        "middle_name": "MAURICIO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2012-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002213",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "85002213",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085002213",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970023229",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin M Coop, D.C.
• Ellaine Cooper-Taillandier, LSW
• Jessica K Cooperkline, BCBA
• Copyright, Inc. of Illinois
• Rachel Cordova
• Core Counseling Services, LLC
• Core Medical, LLC
• Corexcellent, LLC
• Cork Medical LLC
• Cork Medical of Chicago, LLC

• Physician Assistant in Naperville, IL
• Providers in Naperville, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.