Active NPI
Juan A Cornejo, MD
- Family Medicine Physician
- Little River, SC
National Provider Identifier
1154374445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7783
- Practice address
- 4303 Live Oak Drive
Little River, SC 29566 - Phone
- (843) 663-8000
- NPI assigned
- May 18, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7783 | SC | Primary |
Addresses
Primary practice location
4303 Live Oak Drive
Little River, SC 29566
Mailing address
PO Box 547
Little River, SC 29566
Phone (843) 663-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007838 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7783 | SC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1154374445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 547",
"city": "LITTLE RIVER",
"state": "SC",
"postal_code": "29566",
"telephone_number": "843-663-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4303 LIVE OAK DRIVE",
"city": "LITTLE RIVER",
"state": "SC",
"postal_code": "29566",
"telephone_number": "843-663-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNEJO",
"first_name": "JUAN",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "7783",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007838",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little River, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.