NPIMap

Individual provider Active NPI

Kornelia G. Juergensen, MD, PHD, ABFP

  • Family Medicine Physician
  • Marseilles, IL
National Provider Identifier
1477535284
Registry record updated Mar 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-104391 Issued in IL
Practice address
2559 E 2450TH Rd
Marseilles, IL 61341-9749
Phone
(815) 795-5591
Fax
(815) 795-5591
NPI assigned
Nov 17, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 036104391 IL
Family Medicine Physician 207Q00000X 036-104391 IL Primary

Addresses

Primary practice location

2559 E 2450TH Rd
Marseilles, IL 61341-9749

Mailing address

2559 E 2450TH Rd
PO Box 249
Marseilles, IL 61341-9749

Other identifiers 3

IdentifierTypeStateIssuer
036104391MedicaidIL
1477535284MedicaidMO
137710004OtherMOMEDICARE IND #

Other names 1

  • Dr. Kornelia Grosskurth Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036104391ILMDLegal Medicine
036-104391ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Expresscare, LLC Family Medicine Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267574400000",
    "number": "1477535284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2559 E 2450TH RD",
            "address_2": "PO BOX 249",
            "city": "MARSEILLES",
            "state": "IL",
            "postal_code": "613419749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2559 E 2450TH RD",
            "city": "MARSEILLES",
            "state": "IL",
            "postal_code": "613419749",
            "telephone_number": "815-795-5591",
            "fax_number": "815-795-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUERGENSEN",
        "first_name": "KORNELIA",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "MD, PHD, ABFP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-17",
        "last_updated": "2010-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": "036104391",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-104391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104391",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477535284",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IND #",
            "identifier": "137710004",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KORNELIA",
            "last_name": "GROSSKURTH",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marseilles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.