Shemrock Octavio Cordova, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10709 Issued in NV

Practice address

4760 Blue Diamond Rd Ste 110
Las Vegas, NV 89139-7665

Phone

(702) 383-2300

NPI assigned

Feb 8, 2006

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

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Family Practice

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Medical Center of Southern NevadaGroup PAC ID 7315934429, 388 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: scordova5967@direct.umcsn.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.

• University Medical Center of Southern Nevada

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1548393127
  Medicare reassignment Care Compare group NPD
• Meilan L Daguman Aprn PLLC

  • Primary Care Nurse Practitioner
  • Las Vegas, NV
  • NPI 1023568037
  Medicare reassignment NPD

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1689647190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022386",
            "telephone_number": "702-383-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 BLUE DIAMOND RD STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397665",
            "telephone_number": "702-383-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "SHEMROCK",
        "middle_name": "OCTAVIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "10709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Cordova
• Jonathan Cordova
• Kemberly Jissell Cordova
• Pamela Anne Bialoglovski Cordova
• Sean Matthew Cordova
• Yanexy Cordova
• Frank Cordovi Gomez
• Kenia Cordovi Leon
• Terry Cordy Jr.
• Core Drug and Alcohol Treatment Services

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.