Kinsey Cornick, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

69461 Issued in MN

Practice address

8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974

Phone

(952) 993-7400

NPI assigned

Jun 12, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New York Institute of TechnologyGroup PAC ID 3779496039, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• New York Institute of Technology

  • Family Medicine Physician
  • Jonesboro, AR
  • NPI 1760003248

  Single Specialty

  Medicare reassignment Care Compare group NPD
• New York Institute of Technology

  • Family Medicine Physician
  • Old Westbury, NY
  • NPI 1821048612

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1306339502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8455 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443974",
            "telephone_number": "952-993-7400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 Valley Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "NE",
            "postal_code": "685104882",
            "country_code": "US",
            "telephone_number": "402-483-4571",
            "fax_number": "402-483-5633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNICK",
        "first_name": "KINSEY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-12",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "69461",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2018019014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kinsey.cornick.1@9271.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "4600 Valley Rd Ste 200",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685104882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jonathan D Conway
• Madison Conzet
• Heather Elizabeth Cooley, OTR/L
• Alexander Zachary Copelan, M.D.
• Cornerstone Caregiving East LLC
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Megan Courtney, M.A., CCC-SLP
• Danae M Cowell

• Family Medicine Physician in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.