Active NPI
Courtney Racquel Cornick, PH.D.
- Clinical Psychologist
- Hines, IL
National Provider Identifier
1164973707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3422-57
- Practice address
- 5000 S 5TH Ave
Hines VA Hospital/ BLDG 128 RM A114
Hines, IL 60141-3030 - Phone
- (708) 202-8387
- NPI assigned
- Oct 19, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3422-57 | WI | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines VA Hospital/ BLDG 128 RM A114
Hines, IL 60141-3030
Mailing address
664 Lakewood Farms Dr
Bolingbrook, IL 60490-3164
Phone (630) 310-9472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2800 E Enterprise Ave
Suite 333
Appleton, WI 54913-7889
Phone (219) 613-2134
637 N Wells St
Chicago, IL 60654-3707
Phone (877) 219-8726
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3422-57 | WI | MD | Clinical Psychologist |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1164973707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "664 LAKEWOOD FARMS DR",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604903164",
"telephone_number": "630-310-9472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"address_2": "HINES VA HOSPITAL/ BLDG 128 RM A114",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "708-202-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNICK",
"first_name": "COURTNEY",
"middle_name": "RACQUEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-19",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "3422-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.