Individual provider Active NPI

Jason M. Cornelio, PA-C

  • Medical Physician Assistant
  • Bloomfield, CT
National Provider Identifier
1730569740
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3334 Issued in CT
Practice address
711 Cottage Grove Rd
Bloomfield, CT 06002-3060
Phone
(860) 242-8756
Fax
(860) 242-3052
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3334 CT Primary

Addresses

Primary practice location

711 Cottage Grove Rd
Bloomfield, CT 06002-3060

Mailing address

711 Cottage Grove Rd
Bloomfield, CT 06002-3060
Phone (860) 242-8756

Other identifiers 2

IdentifierTypeStateIssuer
1730569740MedicaidCT
D400225889OtherMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20150710000558 CT Practitioner - Physician Assistant 9032421615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

114 Woodland St
Hartford, CT 06105-1208

Hospital & facility affiliations

  • St Francis Hospital & Medical Center Hospital, Hartford, CT, CCN 070002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Jul 6, 2015 Accepting new patients

Locations

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

Interoperability endpoints

  • Direct secure messaging: jcornelio2386715@direct.trinity-health.org

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1730569740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023060",
            "telephone_number": "860-242-8756",
            "fax_number": "860-242-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023060",
            "telephone_number": "860-242-8756",
            "fax_number": "860-242-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIO",
        "first_name": "JASON",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "3334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730569740",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "D400225889",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

Verify at the official NPI Registry.