Individual provider Active NPI

Micah Cornett, MD

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1376121962
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1701 Senate Blvd
Indianapolis, IN 46202-1239
Phone
(317) 962-5975
NPI assigned
Apr 1, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1701 Senate Blvd
Indianapolis, IN 46202-1239

Mailing address

1701 Senate Blvd
Indianapolis, IN 46202-1239

Other practice location 1

1900 Electric Rd
Salem, VA 24153-7474
Phone (720) 683-1117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250110000733 MO Practitioner - Emergency Medicine 4385020965 Reassigns benefits to 1 organization
I20250110000836 FL Practitioner - Emergency Medicine 4385020965 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of Mo, LLC CurrentSince Nov 1, 2024 Accepting new patients
Emergency Medicine Services of FL, LLC CurrentSince Nov 30, 2024 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

105 Tamiami Trl
Fl Tamiami
Port Charlotte, FL 33953

105 Tamiami Trl
Port Charlotte, FL 33953

14000 Fivay Rd
Port Richey, FL 34667
Phone (727) 819-2929

19600 E 39th St S
Independence, MO 64057
Phone (816) 698-7000

403 Burkarth Rd
Warrensburg, MO 64093
Phone (660) 474-2500

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1376121962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SENATE BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SENATE BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-962-5975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Electric Rd",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "VA",
            "postal_code": "241537474",
            "country_code": "US",
            "telephone_number": "720-683-1117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNETT",
        "first_name": "MICAH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-01",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.