Jeremiah Edward Cornwell

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

445 E Dublin Granville Rd
Worthington, OH 43085-3192

Phone

(614) 844-3800

NPI assigned

Sep 15, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Raven Michelle Drake Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1053199646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-844-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-844-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWELL",
        "first_name": "JEREMIAH",
        "middle_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2615030",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAVEN",
            "last_name": "DRAKE",
            "middle_name": "MICHELLE",
            "prefix": "MS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Behavior Technician in Worthington, OH
• Providers in Worthington, OH by specialty
• Behavior Technician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.