Blaine Michael Cornelius, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1251 Issued in NE

Practice address

619 10TH St
Gothenburg, NE 69138-2063

Phone

(308) 537-3674

Fax

(308) 537-3675

NPI assigned

May 19, 2006

Last updated

Jan 31, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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 NE

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Mary Lanning Memorial Hospital AssociationGroup PAC ID 4587575550, shared by 6 NPIs, 129 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mary Lanning Healthcare Hospital, Hastings, NE, CCN 280032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Mary Lanning Memorial Hospital Association

  • Family Medicine Physician
  • Hastings, NE
  • NPI 1356656417
  Medicare reassignment NPD
• The Mary Lanning Memorial Hospital Association

  dba Pathology Professional Services-MLMH

  • Anatomic Pathology & Clinical Pathology Physician
  • Hastings, NE
  • NPI 1760530216
  Medicare reassignment NPD
• Twin Rivers Urgent Care LLC

  • Family Medicine Physician
  • Grand Island, NE
  • NPI 1639248560
  Medicare reassignment NPD
• The Mary Lanning Memorial Hospital Association

  dba Blue Hill Medical Clinic

  • Family Medicine Physician
  • Blue Hill, NE
  • NPI 1629185350

  Physician Assistant

  NPD
• Twin Rivers Urgent Care LLC

  dba Twin Rivers Sports & Family Medicine

  • Family Medicine Physician
  • Grand Island, NE
  • NPI 1588310338
  NPD
• Craig D Bartruff M.D., P.C.

  dba Gothenburg Medical Arts Rural Health Clinic

  • Rural Health Clinic/Center
  • Gothenburg, NE
  • NPI 1487980165
  NPD (past)
• Hastings Family Practice, P.C

  • Family Medicine Physician
  • Hastings, NE
  • NPI 1356383756
  NPD (past)

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

• The Mary Lanning Memorial Hospital Association

  dba Mary Lanning Healthcare Laboratory Services

  • Clinical Medical Laboratory
  • Hastings, NE
  • NPI 1205442258

  Hospital

  Care Compare affiliation
• The Mary Lanning Memorial Hospital Association

  dba Mary Lanning Healthcare

  • Rural Acute Care Hospital
  • Hastings, NE
  • NPI 1831203488
  Care Compare affiliation

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359590400000",
    "number": "1811941404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 389",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691380389",
            "telephone_number": "308-537-3674",
            "fax_number": "308-537-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 10TH ST",
            "city": "GOTHENBURG",
            "state": "NE",
            "postal_code": "691382063",
            "telephone_number": "308-537-3674",
            "fax_number": "308-537-3675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "BLAINE",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2013-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hunter Brimm
• Sue Britt
• Carol Shackleton, M.D., P.C.
• Christopher P Costa MD PC (Costa Family Practice)
• City of Gothenburg (Gothenburg Vol. Fire Dept.)
• Craig D Bartruff M.D., P.C. (Gothenburg Medical Arts Rural Health Clinic)
• Craig D Bartruff, M.D., P.C. (Gothenburg Medical Arts Rural Health Clinic)
• John Alan Daup, OTR/L
• David Hult, M.D., P.C.
• Carson Lee Davis

• Physician Assistant in Gothenburg, NE
• Providers in Gothenburg, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.