Annie Kathryn Kornetzke, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12784879-1204 Issued in UT

Practice address

4745 S 3200 W
Taylorsville, UT 84129-2822

Phone

(801) 964-6214

Fax

(877) 497-4661

NPI assigned

Jun 5, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Chicago College of Osteopathy, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Centers IncGroup PAC ID 5991698169, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: akornetzke588383@direct.med.utah.edu
• FHIR API: https://fhir4.healow.com/fhir/r4/ACFCAA
• Direct secure messaging: annie.kornetzke@chcsl.eclinicaldirectplus.com

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.

• Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • West Valley City, UT
  • NPI 1952505117

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Midvale, UT
  • NPI 1073611364

  Family Medicine

  NPD
• Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • West Valley City, UT
  • NPI 1326417445

  Family Medicine

  NPD
• Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Taylorsville, UT
  • NPI 1801992953

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1053979948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 S 3270 W",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841191119",
            "telephone_number": "385-261-2614",
            "fax_number": "877-497-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 S 3200 W",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841292822",
            "telephone_number": "801-964-6214",
            "fax_number": "877-497-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNETZKE",
        "first_name": "ANNIE",
        "middle_name": "KATHRYN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-05",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125074527",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12784879-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David K Knowlton, DDS
• Spencer Koehler
• Frane Koekemoer
• Madison Kohler
• Connor Koppes
• Karissa Korth
• Matthew Rey Koster, DO
• Dakota Kovach
• Garrett Kovach
• Madison Kraft

• Family Medicine Physician in Taylorsville, UT
• Providers in Taylorsville, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.