Shane A Cordrey

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

54923 Issued in CA

Practice address

28780 Single Oak Dr Ste 260
Temecula, CA 92590-5534

Phone

(951) 676-4193

NPI assigned

Jan 13, 2016

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rancho Family Medical Group IncGroup PAC ID 6305741240, 112 clinicians

Omar Osman Practice, LLCGroup PAC ID 4385014042, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Temecula Valley Hospital Hospital, Temecula, CA, CCN 050775

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: scordrey181881@direct.llu.edu

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.

• Rancho Family Medical Group, Inc.

  dba Platinum Women's Health and Wellness

  • Family Medicine Physician
  • Temecula, CA
  • NPI 1598791600
  Medicare reassignment Care Compare group
• Omar Osman Practice, LLC

  dba Comprehensive Rehab Consultants PC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1669192472
  Care Compare group
• Rincon Health Network

  • Health Service Clinic/Center
  • Temecula, CA
  • NPI 1902697832
  NPD
• UC San Diego Health - Rancho Family Medical Group

  • Multi-Specialty Clinic/Center
  • Temecula, CA
  • NPI 1003385071
  NPD (past)

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

• Temecula Valley Hospital Inc

  dba Temecula Valley Hospital

  • General Acute Care Hospital
  • Temecula, CA
  • NPI 1679816201
  Care Compare affiliation

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1508222084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28780 SINGLE OAK DR STE 260",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905534",
            "telephone_number": "951-676-4193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28780 SINGLE OAK DR STE 260",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905534",
            "telephone_number": "951-676-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDREY",
        "first_name": "SHANE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-13",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "2936",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabatha C. Coots
• John Michael Vincent Coralde, MD
• Jesus Alejandro Cordova Guilarte, MD, SA-C
• Jessica Marie Cordova
• Maricela Moran Cordova, LCSW
• Camila Ximena Coria
• Justin Coria
• Mercedes Denise Corlew, PA
• Jamie Tomoko Cornejo
• Marlon Cornejo

• Physician Assistant in Temecula, CA
• Providers in Temecula, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.