Individual provider Active NPI

Cory M Stanley, PA

  • Physician Assistant
  • Suwanee, GA
National Provider Identifier
1992825152
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116822 Issued in FL
Practice address
3245 Peachtree Pkwy # D188
Suwanee, GA 30024-6054
Phone
(888) 353-6843
Fax
(912) 303-7167
NPI assigned
Mar 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-01166 NC
Physician Assistant 363A00000X 005034 GA
Physician Assistant 363A00000X PA9116822 FL Primary

Addresses

Primary practice location

3245 Peachtree Pkwy # D188
Suwanee, GA 30024-6054

Mailing address

1103 Lakeshore Dr
Jupiter, FL 33458-8390
Phone (828) 275-1860

Other practice location 1

9060 N Military Trl
Palm Beach Gardens, FL 33410-5972
Phone (561) 295-8822

Other identifiers 13

IdentifierTypeStateIssuer
01061992OtherGAAMERIGROUP
567447065FOtherGAMEDICAID ID FOR URGENTONE
GPA892OtherSCMEDICAID GROUP ID FOR URGENTONE
P00441750OtherGARR MEDICARE ID FOR URGENTONE
0580PAOtherSCMEDICAID ID FOR URGENTONE
567447065BMedicaidGA
567447065MedicaidGA
567447065EOtherGAMEDICAID ID FOR URGENTONE
567447065CMedicaidGA
567447065AMedicaidGA
511I970040OtherGAMEDICARE ID FOR URGENTONE
GPA9002OtherSCMEDICAID GROUP ID FOR URGENTONE
567447065DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 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

Enrollment IDStateProvider typePAC IDDetails
I20070510000122 GA Practitioner - Physician Assistant 1759487655 Reassigns benefits to 2 organizations
I20130604000747 FL Practitioner - Physician Assistant 1759487655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Care by PhoneGroup PAC ID 1456889922, 3 clinicians

Practice addresses (Care Compare)

10094 W Indiantown Rd
Suite B
Jupiter, FL 33478-4723
Phone (561) 725-7180

Hospital & facility affiliations

  • Jupiter Medical Center Hospital, Jupiter, FL, CCN 100253

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-01166NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Skidaway Medical Group LLC CurrentSince Nov 11, 2021 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients
Memorial Health Urgentone, Inc. Physician Assistant Past Accepting new patients
MD Now Medical Centers Inc Past Accepting new patients

Locations

212 Johnny Mercer Blvd
#B
Savannah, GA 31410
Phone (912) 201-1140

5730 Ogeechee Rd
Ste 192
Savannah, GA 31405
Phone (912) 201-1140

310 Eisenhower Dr
Ste 12A
Savannah, GA 31406
Phone (912) 201-1140

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1992825152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 LAKESHORE DR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588390",
            "telephone_number": "828-275-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 PEACHTREE PKWY # D188",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246054",
            "telephone_number": "888-353-6843",
            "fax_number": "912-303-7167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9060 N Military Trl",
            "address_purpose": "LOCATION",
            "city": "Palm Beach Gardens",
            "state": "FL",
            "postal_code": "334105972",
            "country_code": "US",
            "telephone_number": "561-295-8822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANLEY",
        "first_name": "CORY",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-01166",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005034",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01061992",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ID FOR URGENTONE",
            "identifier": "567447065F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP ID FOR URGENTONE",
            "identifier": "GPA892",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE ID FOR URGENTONE",
            "identifier": "P00441750",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ID FOR URGENTONE",
            "identifier": "0580PA",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567447065B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567447065",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ID FOR URGENTONE",
            "identifier": "567447065E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567447065C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567447065A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID FOR URGENTONE",
            "identifier": "511I970040",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP ID FOR URGENTONE",
            "identifier": "GPA9002",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567447065D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suwanee, GA

Sources for this page

Verify at the official NPI Registry.