Individual provider Active NPI

Kathleen N Cornell, P.A.

  • Medical Physician Assistant
  • Long Grove, IL
National Provider Identifier
1447295381
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
385000378 Issued in IL
Practice address
3880 Salem Lake Dr Ste F
Long Grove, IL 60047-5292
Phone
(847) 719-2220
Fax
(847) 719-2265
NPI assigned
Jun 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 385000378 IL Primary

Addresses

Primary practice location

3880 Salem Lake Dr Ste F
Long Grove, IL 60047-5292

Mailing address

3880 Salem Lake Dr Ste F
Long Grove, IL 60047-5292
Phone (847) 719-2220

Other identifiers 1

IdentifierTypeStateIssuer
085001000MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kcornell261984@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTRU2/

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20071214000731 IL Practitioner - Physician Assistant 6800819244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

450 W Hwy 22
Barrington, IL 60010-1919
Phone (847) 381-9600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
385000378ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Best Practices Inpatient Care, LTD. CurrentSince Feb 10, 2022 Accepting new patients
Best Practices Inpatient Care,LTD CurrentSince Feb 10, 2022 Accepting new patients

Locations

800 W Central Rd
Arlington Hts, IL 60005
Phone (847) 618-6150

106 Barrington Commons Ct
Unit 1790
Barrington, IL 60011
Phone (847) 719-2220

3880 Salem Lake Dr
#F
Long Grove, IL 60047
Phone (847) 235-3072

3880 Salem Lake Dr
Ste F
Long Grove, IL 60047
Phone (847) 719-2220

450 W State Route 22
South Barrington, IL 60010
Phone (847) 381-0123

Interoperability endpoints

  • Direct secure messaging: kcornellweld235892@direct.myadvocateaurora.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1447295381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 SALEM LAKE DR STE F",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475292",
            "telephone_number": "847-719-2220",
            "fax_number": "847-719-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3880 SALEM LAKE DR STE F",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475292",
            "telephone_number": "847-719-2220",
            "fax_number": "847-719-2265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELL",
        "first_name": "KATHLEEN",
        "middle_name": "N",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2023-03-07",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "385000378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085001000",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcornell261984@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3880 Salem Lake Dr Ste F",
            "city": "Long Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600475292",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTRU2/",
            "affiliation": "N",
            "address_1": "3880 Salem Lake Dr Ste F",
            "city": "Long Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600475292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Long Grove, IL

Sources for this page

Verify at the official NPI Registry.