Active NPI
Clay Cornelison, DO
- Psychiatry Physician
- Pocatello, ID
National Provider Identifier
1609454040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 222123
- Practice address
- 500 S 11TH Ave
Pocatello, ID 83201-4835 - Phone
- (208) 232-6214
- NPI assigned
- Mar 29, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 222123 | ID | Primary |
Addresses
Primary practice location
500 S 11TH Ave
Pocatello, ID 83201-4835
Mailing address
500 S 11TH Ave
Pocatello, ID 83201-4835
Phone (208) 232-6214
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 222123 | ID | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771891200000",
"number": "1609454040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 S 11TH AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014835",
"telephone_number": "208-232-6214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S 11TH AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014835",
"telephone_number": "208-232-6214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELISON",
"first_name": "CLAY",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-29",
"last_updated": "2026-02-24",
"certification_date": "2026-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ID",
"license": "222123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.