Cory Stephen Davenport, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

10807 Issued in AZ

Practice address

1200 N Beaver St
Flagstaff, AZ 86001-3118

Phone

(928) 773-2332

NPI assigned

Sep 3, 2008

Last updated

Feb 6, 2025By 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

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Enloe Medical CenterGroup PAC ID 9739092388, 330 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enloe Health Hospital, Chico, CA, CCN 050039

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cdavenport50554@enloedirect.org

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.

• Enloe Medical Center

  dba Enloe Trauma & Surgery Clinic

  • Surgery Physician
  • Chico, CA
  • NPI 1477975613
  Medicare reassignment Care Compare group NPD
• Northern Arizona Healthcare Corporation

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1669914552
  Medicare reassignment Care Compare group
• Enloe Medical Center

  dba Enloe Prompt Care

  • Urgent Care Clinic/Center
  • Chico, CA
  • NPI 1396753281
  Medicare reassignment
• Svmhs Clinics

  dba Salinas Valley Health Clinics

  • Multi-Specialty Clinic/Center
  • Salinas, CA
  • NPI 1093158347
  Medicare reassignment
• Northern Arizona Healthcare Corporation

  dba Northern Arizona Healthcare Children's Health Center

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1235732702
  NPD
• Enloe Medical Center

  dba Enloe Cardiology Services

  • Cardiovascular Disease Physician
  • Chico, CA
  • NPI 1720099328
  NPD
• Svmhs Clinics

  • Physical Therapist
  • Salinas, CA
  • NPI 1518486893
  NPD
• Dignity Health

  dba Mercy Medical Center Redding

  • General Acute Care Hospital
  • Redding, CA
  • NPI 1477671535
  NPD (past)
• Enloe Medical Center

  dba Enloe Digestive Diseases Clinic

  • Gastroenterology Physician
  • Chico, CA
  • NPI 1801226162
  NPD (past)
• Lancelot O Alexander MD a Medical Corporation

  • Specialist
  • Salinas, CA
  • NPI 1134279532
  NPD (past)
• Owensboro Health Medical Group, Inc

  dba Owensboro Health Cardiothoracic Surgery

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Owensboro, KY
  • NPI 1447203385

  Physician Assistant

  NPD (past)

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

• Enloe Medical Center

  • General Acute Care Hospital
  • Chico, CA
  • NPI 1417901091
  Care Compare affiliation

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1730337858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7259 S BINGHAM JUNCTION BLVD",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840474860",
            "telephone_number": "866-615-5536",
            "fax_number": "866-588-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-773-2332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 W Acacia St Ste 23",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952032454",
            "country_code": "US",
            "telephone_number": "209-242-7098",
            "fax_number": "209-461-7579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "CORY",
        "middle_name": "STEPHEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "55215",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "10807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Todd Daniel, M.D
• Brian J Daniels, LAC
• Darlene M Lee MD PC
• Brynne Daulton
• Jim E Daulton Jr.
• Emily Davenport, NMD
• David L. McGarey MD PC
• Andrew David, M.D.
• Daniel Davidson, PHD, BCBA-D
• Dore Davidson, SLP

• Surgical Physician Assistant in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; 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.