Jennifer Marlen Cordovi Tirado

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

900 N Heritage Dr
Ridgecrest, CA 93555-5536

Phone

(760) 446-4571

NPI assigned

May 3, 2021

Sex

Female

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 AL, CA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Douglas E Roberts Jr MD a Professional Corporation

  • Internal Medicine Physician
  • Ridgecrest, CA
  • NPI 1386899268
  Medicare reassignment
• Phenix City Spine & Joint Ctr.

  • Chiropractor
  • Phenix City, AL
  • NPI 1053330340
  NPD (past)

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1902489586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N HERITAGE DR",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935555536",
            "telephone_number": "760-446-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N HERITAGE DR",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935555536",
            "telephone_number": "760-446-4571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 S Railroad St Ste B",
            "address_purpose": "LOCATION",
            "city": "Phenix City",
            "state": "AL",
            "postal_code": "368672994",
            "country_code": "US",
            "telephone_number": "877-495-7773",
            "fax_number": "866-537-1711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORDOVI TIRADO",
        "first_name": "JENNIFER",
        "middle_name": "MARLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63430",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Rae Conway, NP
• Lindsay Marie Cook
• Theresa Marie Cook
• Yvette Pringle Cook
• Paul S Cooper, OTR/L
• Lawrence N. Cosner Jr., MD
• County of Kern
• County of Kern
• Stephanie Crapo, MD
• Heather Ann Creel, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.