Edward Vincent Kornuszko, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9078 Issued in FL

Practice address

964 Megano Blvd
Deland, FL 32724-6502

Phone

(781) 835-5664

NPI assigned

Aug 6, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

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.

• Edward V Kornuszko Psy D PA

  • Clinical Psychologist
  • Deland, FL
  • NPI 1225748569
  Medicare reassignment NPD Authorized official
• Pro Performance Physical Therapy LLC

  • Physical Therapist
  • Fort Lauderdale, FL
  • NPI 1215598529
  NPD (past)

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1679982375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 MEGANO BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327246502",
            "telephone_number": "781-835-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 MEGANO BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327246502",
            "telephone_number": "781-835-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNUSZKO",
        "first_name": "EDWARD",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-06",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iliya Khramov, M.D.
• Susan Kimeria
• Justin P Kittredge, MD
• Kaylin Mae Kluvi, CSTFA
• Alissa Knight, LCSW
• Andrew J Kovachy, ATC, LAT
• Wesley Kramer, MD
• Tina Marie Krautheim
• David Allen Krazeise, M.S, ATC, LAT
• Lisa A Krebs, AUD

• Clinical Psychologist in Deland, FL
• Providers in Deland, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.