Jennifer Aileen Correll, BA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3451 Issued in TN

Practice address

119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998

Phone

(423) 282-1480

NPI assigned

Sep 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

BH Services Southeast 1 PCGroup PAC ID 7012457054, 96 clinicians

Ipc Pac Healthcare Services of Tennessee PCGroup PAC ID 0840587572, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts, Doctor of Philosophy

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.

• BH Services Southeast 1 PC

  • Nurse Practitioner
  • Brownsville, TN
  • NPI 1164251526

  TN

  Medicare reassignment Care Compare group NPD
• Ipc Pac Healthcare Services of Tennessee PC

  • Internal Medicine Physician
  • Bristol, TN
  • NPI 1104277656

  TN

  Medicare reassignment Care Compare group NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  TN

  Medicare reassignment NPD
• CS Pacs 3 Southeast, LLC

  • Hospitalist Physician
  • Bluefield, WV
  • NPI 1154104958

  TN

  Medicare reassignment NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809

  TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1457545402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORRELL",
        "first_name": "JENNIFER",
        "middle_name": "AILEEN",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-04",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "3451",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1277",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makayla Cornelius, MD
• Cornerstone Caregiving East LLC
• Tasha Cornett, FNP
• Larry W Cornwell, CRNA
• James Coronel
• Christine Susan Corsberg, PHARMD., BCPS
• Holly Corwin
• Kimberly A. Costello, PT, DPT
• Pamela J Costello, MD
• Patrick Nicholas Costello, MD

• All providers in Johnson City, TN
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2017; 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.