Active NPI
Cory M Stanley, PA
- Physician Assistant
- Suwanee, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9116822
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01061992 | Other | GA | AMERIGROUP |
| 567447065F | Other | GA | MEDICAID ID FOR URGENTONE |
| GPA892 | Other | SC | MEDICAID GROUP ID FOR URGENTONE |
| P00441750 | Other | GA | RR MEDICARE ID FOR URGENTONE |
| 0580PA | Other | SC | MEDICAID ID FOR URGENTONE |
| 567447065B | Medicaid | GA | |
| 567447065 | Medicaid | GA | |
| 567447065E | Other | GA | MEDICAID ID FOR URGENTONE |
| 567447065C | Medicaid | GA | |
| 567447065A | Medicaid | GA | |
| 511I970040 | Other | GA | MEDICARE ID FOR URGENTONE |
| GPA9002 | Other | SC | MEDICAID GROUP ID FOR URGENTONE |
| 567447065D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 Phone
Practice addresses (Care Compare)
10094 W Indiantown Rd
Suite B
Jupiter, FL 33478-4723
Phone (561) 725-7180
Hospital & facility affiliations
- Jupiter Medical Center
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.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-01166 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Skidaway Medical Group LLC | Current | 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.
-
- Pediatrics Physician
- Savannah, GA
- NPI 1073046397
-
- Emergency Medicine Physician
- Savannah, GA
- NPI 1801818844
Physician Assistant
-
- Urgent Care Clinic/Center
- West Palm Beach, FL
- NPI 1033195474
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.