Edgar D Cornejo, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1100-P.A. Issued in PR

Practice address

14175 W Indian School Rd Ste B4-120
Goodyear, AZ 85395-8407

Phone

(956) 222-7774

NPI assigned

Oct 21, 2021

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 names 1

• Edgar De Jesus Cornejo Lomeli Other name

Medicare fee-for-service enrollment

Enrolled in AZ

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, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arizona Health Services PLLCGroup PAC ID 5193941144, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Arizona Health Services PLLC

  • Physical Medicine & Rehabilitation Physician
  • Phoenix, AZ
  • NPI 1659796985
  Medicare reassignment Care Compare group
• Arizona Health Services PLLC

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1386267524
  NPD

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1912660440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14175 W INDIAN SCHOOL RD STE B4-120",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958407",
            "telephone_number": "956-222-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14175 W INDIAN SCHOOL RD STE B4-120",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958407",
            "telephone_number": "956-222-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNEJO",
        "first_name": "EDGAR",
        "middle_name": "D",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-21",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "1100-P.A.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDGAR",
            "last_name": "CORNEJO LOMELI",
            "middle_name": "DE JESUS",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cassidy Cooney, PT
• Lacey Cooper, PTA
• Copper Star Medical Supply
• Collin Robert Cordery, AU.D.
• James Cole Cornall
• Cornerstone Medical Center LLC
• Tirsah A Cortez, PHARMD
• Claudio Cosio, DMD
• Chung Counihan
• Amy Lee Cowgill, BA

• Physician Assistant in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.