Individual provider Active NPI

Curtis L Cornella-Carlson, DO

  • Obstetrics & Gynecology Physician
  • Wauwatosa, WI
National Provider Identifier
1205867611
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
45926 Issued in WI
Practice address
3289 N Mayfair Rd
Wauwatosa, WI 53222
Phone
(414) 771-7900
Fax
(414) 607-6336
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 45926 WI Primary

Addresses

Primary practice location

3289 N Mayfair Rd
Wauwatosa, WI 53222

Mailing address

3003 W Good Hope Rd
Milwaukee, WI 53209
Phone (414) 352-3100

Other identifiers 2

IdentifierTypeStateIssuer
43508400MedicaidWI
P00823715OtherWIRR MEDICARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ccornellacarlson195@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20040331001433 WI Practitioner - Obstetrics/Gynecology 0244222149

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Jan 1, 2008 Accepting new patients
Aurora Advanced Healthcare, Inc. Obstetrics & Gynecology CurrentSince Jan 1, 2008 Accepting new patients
Advanced Healthcare SC Obstetrics & Gynecology Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

215 Washington St
Grafton, WI 53024
Phone (262) 375-3700

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

7878 N 76th St
Milwaukee, WI 53223
Phone (414) 354-6434

12901 W National Ave
New Berlin, WI 53151
Phone (262) 782-7770

3289 N Mayfair Rd
Wauwatosa, WI 53222
Phone (414) 771-7900

Interoperability endpoints

  • Direct secure messaging: ccornellacarlson195@direct.myadvocateaurora.org

Organizations & group practices 3

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1205867611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 W GOOD HOPE RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53209",
            "telephone_number": "414-352-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3289 N MAYFAIR RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "53222",
            "telephone_number": "414-771-7900",
            "fax_number": "414-607-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELLA-CARLSON",
        "first_name": "CURTIS",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "45926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43508400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00823715",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccornellacarlson195@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3289 N Mayfair Rd",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3289 N Mayfair Rd",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.