Cora M Haze, P.A. – Physician Assistant

Key facts

NPI: 1992747265
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 11480 (AZ)
Practice address: 509 E Main St
Rogue River, OR 97537-9674
Phone: (541) 582-0505
Fax: (541) 582-0778
NPI assigned: Jun 12, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Rogue River Family Practice Clinic PC Family Medicine Physician · Rogue River, OR · NPI 1477613529

Medicare reassignment OR

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2003
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

261 N Roosevelt Ave
Chandler, AZ 85226-2616

6824 E Doubletree Ranch Rd
Paradise Valley, AZ 85253-1918

Medicare participation

Medicare fee-for-service enrollment: Enrolled in OR
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20041026000133	OR	Practitioner - Physician Assistant	0244291904	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
PA00956	OR	MD	Physician Assistant

Interoperability endpoints

Direct secure messaging: corahaze@rrfpc.allscriptsdirect.net

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	11480	AZ	Yes
Physician Assistant	363A00000X	PA00956	OR

Addresses

Primary practice location

509 E Main St
Rogue River, OR 97537-9674

Mailing address

261 N Roosevelt Ave
Chandler, AZ 85226-2617
Phone (480) 677-8282

Other practice location 1

287 E Hunt Hwy Ste 105
San Tan Valley, AZ 85143-5096
Phone (480) 677-8282

Other identifiers

Identifier	Type	State	Issuer
00000	Medicaid	OR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 10, 2026.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1992747265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 N ROOSEVELT AVE",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262617",
            "telephone_number": "480-677-8282",
            "fax_number": "888-316-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 E MAIN ST",
            "city": "ROGUE RIVER",
            "state": "OR",
            "postal_code": "975379674",
            "telephone_number": "541-582-0505",
            "fax_number": "541-582-0778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "287 E Hunt Hwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "San Tan Valley",
            "state": "AZ",
            "postal_code": "851435096",
            "country_code": "US",
            "telephone_number": "480-677-8282",
            "fax_number": "888-316-1686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZE",
        "first_name": "CORA",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11480",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00956",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogue River, OR

All providers in Rogue River, OR · Physician Assistant in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.