Active NPI
Kelly Lynn Cornelison, PA-C, R.T. (R)
- Physician Assistant
- Durham, NC
National Provider Identifier
1043817620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-14464
- Practice address
- 20 Duke Medicine Cir # 2-2
Durham, NC 27710-2000 - Phone
- (919) 668-6688
- NPI assigned
- Oct 6, 2020
- Sex
- Female
- 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 | 0010-14464 | NC | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | MA | ||
| Physician Assistant | 363A00000X | PA8440 | MA |
Addresses
Primary practice location
20 Duke Medicine Cir # 2-2
Durham, NC 27710-2000
Mailing address
20 Duke Medicine Cir # 2-2
Durham, NC 27710-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
20 Duke Medicine Cir
Durham, NC 27710-2000
Phone (919) 684-8111
40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111
Hospital & facility affiliations
- Duke University Hospital
- Duke Regional Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA8440 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duke Health Integrated Practice, Inc. | Current | Accepting new patients | |
| Duke Health Integrated Practice, Inc | Current | Accepting new patients |
Locations
20 Duke Medicine Cir
Durham, NC 27710
Phone (919) 668-6608
20 Duke Medicine Cir
#22
Durham, NC 27710
Phone (919) 668-6688
40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588
Interoperability endpoints
- kcornelison588390@direct.medicine.duke.edu
- kcornelison49002@tuftsmedicine.direct-ci.com
Organizations & group practices 4
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.
-
- General Practice Physician
- Durham, NC
- NPI 1205553369
-
- Emergency Medicine Physician
- Reading, MA
- NPI 1184066912
-
- Emergency Medicine Physician
- Melrose, MA
- NPI 1790730539
-
- Orthopaedic Foot and Ankle Surgery Physician
- Durham, NC
- NPI 1518725936
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rehabilitation Hospital Unit
- Raleigh, NC
- NPI 1205225646
-
- Rehabilitation Hospital Unit
- Durham, NC
- NPI 1538166061
-
- General Acute Care Hospital
- Durham, NC
- NPI 1871592113
-
- General Acute Care Hospital
- Durham, NC
- NPI 1992703540
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727395200000",
"number": "1043817620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 DUKE MEDICINE CIR # 2-2",
"city": "DURHAM",
"state": "NC",
"postal_code": "277102000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 DUKE MEDICINE CIR # 2-2",
"city": "DURHAM",
"state": "NC",
"postal_code": "277102000",
"telephone_number": "919-668-6688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELISON",
"first_name": "KELLY",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "PA-C, R.T. (R)",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-06",
"last_updated": "2024-09-27",
"certification_date": "2024-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-14464",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA8440",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.