Individual provider Active NPI

Richard Cordle, MD

  • Pediatric Gastroenterology Physician
  • Roanoke, VA
National Provider Identifier
1356313241
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
0101-233252 Issued in VA
Practice address
4348 Electric Rd
Roanoke, VA 24018-0720
Phone
(540) 769-0976
Fax
(540) 857-5391
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101-233252 VA
Pediatric Gastroenterology Physician 2080P0206X 0101-233252 VA Primary

Addresses

Primary practice location

4348 Electric Rd
Roanoke, VA 24018-0720

Mailing address

3027 Circle Dr SW
Roanoke, VA 24018-2107

Other identifiers 3

IdentifierTypeStateIssuer
010383722MedicaidVA
1356313241MedicaidVA
6702708MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101102001311 VA Practitioner - Pediatric Medicine 5991999062 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101-233252VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Jul 18, 2010 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jun 23, 2020 Accepting new patients
Carilion Healthcare Corporation CurrentSince Jun 23, 2020 Accepting new patients
Carilion Medical Center CurrentSince Jul 18, 2010 Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Carilion Medical Center Past Accepting new patients

Locations

1107 Brookdale St
Martinsville, VA 24112
Phone (276) 634-0005

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

102 Highland Ave SE
Roanoke, VA 24013
Phone (540) 985-9835

213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677

4348 Electric Rd
Roanoke, VA 24018
Phone (540) 769-0600

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: rcordle18540@direct.carilionclinic.org

Organizations & group practices 7

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1356313241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 CIRCLE DR SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240182107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4348 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240180720",
            "telephone_number": "540-769-0976",
            "fax_number": "540-857-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDLE",
        "first_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101-233252",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "VA",
            "license": "0101-233252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010383722",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356313241",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6702708",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.