Kathleen Korneli-Gradowski, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601002243 Issued in MI

Practice address

461 W Huron St
Nomc Family Practice Center
Pontiac, MI 48341-1601

Phone

(248) 857-7160

Fax

(248) 857-7141

NPI assigned

Nov 15, 2006

Sex

Female

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

• Kathleen Korneli Former name

Medicare fee-for-service enrollment

Enrolled in MI

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, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fadi Salloum MD PCGroup PAC ID 2062503584, 28 clinicians

Practice addresses (Care Compare)

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.

• Fadi Salloum MD PC

  dba Impact

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1053510446
  Medicare reassignment Care Compare group
• Telemed Consultants PLLC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1699398347
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033282520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 W HURON ST",
            "address_2": "NOMC FAMILY PRACTICE CENTER",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411601",
            "telephone_number": "248-857-7160",
            "fax_number": "248-857-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 W HURON ST",
            "address_2": "NOMC FAMILY PRACTICE CENTER",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411601",
            "telephone_number": "248-857-7160",
            "fax_number": "248-857-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNELI-GRADOWSKI",
        "first_name": "KATHLEEN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "KORNELI",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lyndsey Kondor
• Koni's Afc Home
• Melissa Konopka, CRNA
• John NMN Kopin, DDS
• Ryan Korlewitz, DO
• Nichole Kosmalski
• Kristin Koss, NP
• Sharon Michelle Kossman, MSW
• Tina Kosten
• Nikhil Kumar Kotla, MD

• Physician Assistant in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.