Individual provider Active NPI

Courtney Grace Lipscomb Cornelius

  • Family Nurse Practitioner
  • Gadsden, AL
National Provider Identifier
1508412685
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-146216 Issued in AL
Practice address
1007 Goodyear Ave
Gadsden, AL 35903-1195
Phone
(256) 494-4000
NPI assigned
Aug 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-146216 AL Primary

Addresses

Primary practice location

1007 Goodyear Ave
Gadsden, AL 35903-1195

Mailing address

524 Garmon Rd
Gadsden, AL 35901-9090
Phone (256) 553-1693

Other names 1

  • Miss Courtney Grace Lipscomb Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20191221000701 AL Practitioner - Nurse Practitioner 4284068404 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gadsden HB Medical Services LLCGroup PAC ID 4183078561, 58 clinicians

Practice addresses (Care Compare)

1007 Goodyear Ave
Gadsden, AL 35903-1195
Phone (256) 494-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-146216ALMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gadsden HB Medical Services LLC CurrentSince Oct 8, 2023 Accepting new patients
App of Alabama Ed PLLC CurrentSince Oct 15, 2019 Accepting new patients

Locations

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

1007 Goodyear Ave
Gadsden, AL 35903
Phone (256) 494-4000

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

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.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1508412685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 GARMON RD",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359019090",
            "telephone_number": "256-553-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 GOODYEAR AVE",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359031195",
            "telephone_number": "256-494-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPSCOMB CORNELIUS",
        "first_name": "COURTNEY",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-14",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-146216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "LIPSCOMB",
            "middle_name": "GRACE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gadsden, AL

Sources for this page

Verify at the official NPI Registry.