Jordan Riley Cormack, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1901 Clinch Ave
Knoxville, TN 37916-2307

Phone

(865) 541-1111

NPI assigned

Jan 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Knoxville Heart Group, Inc.Group PAC ID 4284761917, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125
• Claiborne Medical Center Hospital, Tazewell, TN, CCN 440057

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cormack.jordan.riley@covenanthealth.cernerdirect.com

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.

• Knoxville Heart Group, Inc.

  • Cardiovascular Disease Physician
  • Knoxville, TN
  • NPI 1710218508
  Medicare reassignment Care Compare group
• Knoxville Heart Group PC

  • Cardiovascular Disease Physician
  • Knoxville, TN
  • NPI 1821087628
  NPD (past)

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

• Claiborne Medical Center

  • General Acute Care Hospital
  • Tazewell, TN
  • NPI 1942205166
  Care Compare affiliation
• Fort Sanders Regional Medical Center

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1942294814
  Care Compare affiliation

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1548890247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9056 HIGHBRIDGE DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379221439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CLINCH AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162307",
            "telephone_number": "865-541-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORMACK",
        "first_name": "JORDAN",
        "middle_name": "RILEY",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-22",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q056756",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cormack.jordan.riley@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1901 Clinch Ave",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379162307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Core Surgical Inc
• Daniel Core, MD
• William Core, PT
• Jessica Mosley Corea
• Sherrie Corgan, FNP-C
• Julie Corn
• Amanda Cornatzer, MAT
• Hannah Cornelius, DPT
• Theresa Marie Cornelius, MS, RD, LDN
• Cornerstone Caregiving East LLC

• Medical Physician Assistant in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.