Jesus Angel Corn Sotelo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1422 Issued in NV

Practice address

6355 S Buffalo Dr FL 3
Las Vegas, NV 89113-2133

Phone

(702) 216-3346

Fax

(702) 671-6883

NPI assigned

Feb 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jesus Angel Corn Former name

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jesuscornsotelo@hcpnv.allscriptsdirect.net

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.

• Intermountain Medical Holdings Nevada Inc

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279
  Medicare reassignment
• Intermountain Medical Holdings Nevada Inc

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1689882557
  NPD
• True North Health Navigation LLC

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1740622133
  NPD (past)

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1285973289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR FL 3",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346",
            "fax_number": "702-671-6883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4225 S Eastern Ave Ste 8",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891195485",
            "country_code": "US",
            "telephone_number": "702-982-5786",
            "fax_number": "702-982-5871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORN SOTELO",
        "first_name": "JESUS",
        "middle_name": "ANGEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-11",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285973289",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA1422",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESUS",
            "last_name": "CORN",
            "middle_name": "ANGEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jannet A Corless
• Sean Corley, M.A., BCBA, LBA
• Adrian Corliss
• Amanda Cormican, APRN, CPNP-PC
• Christopher John Cormier, R.PH
• Ionel Cornea, PT
• Claudia Cornejo
• Jaime Cornejo
• Lorena Cornejo
• Maria Lorena Cornejo, RN

• Medical Physician Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Medical Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.