NPIMap

Individual provider Active NPI

Adam R. Corneliussen, PA-C

  • Medical Physician Assistant
  • Anchorage, AK
National Provider Identifier
1821490301
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
104245 Issued in AK
Practice address
3801 Lake Otis Pkwy
Suite 300
Anchorage, AK 99508-5234
Phone
(907) 562-2277
Fax
(907) 563-3460
NPI assigned
Sep 16, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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 104245 AK Primary

Addresses

Primary practice location

3801 Lake Otis Pkwy
Suite 300
Anchorage, AK 99508-5234

Mailing address

3801 Lake Otis Pkwy
Suite 300
Anchorage, AK 99508-5234
Phone (907) 562-2277

Other practice location 1

3125 E Meridian Park Loop Ste 300
Wasilla, AK 99654-7528
Phone (907) 562-2277

Other identifiers 1

IdentifierTypeStateIssuer
1636106MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151222001728 AK Practitioner - Physician Assistant 1557662210 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
Orthoalaska LLC 167 clinicians

Practice addresses (Care Compare)

3125 E Meridian Park Loop
Suite 300
Wasilla, AK 99654-7528
Phone (907) 357-2267

3801 Lake Otis Pkwy
Anchorage, AK 99508-5234

Hospital & facility affiliations

  • Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006

Merit-based Incentive Payment System (MIPS)

Final score
75.68 of 100Reported as group
Quality
52.97
Promoting interoperability
88
Improvement activities
40
Cost
73.9

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthoalaska LLC CurrentSince Jan 17, 2016 Accepting new patients
Orthoalaska LLC PastSince Jan 21, 2024 Accepting new patients

Locations

3801 Lake Otis Pkwy
Ste 300
Anchorage, AK 99508
Phone (907) 341-5238

13015 Old Glenn Hwy
Ste 100
Eagle River, AK 99577

3125 E Meridian Park Loop
Ste 150
Wasilla, AK 99654
Phone (907) 864-5025

3125 E Meridian Park Loop
Ste 300
Wasilla, AK 99654
Phone (907) 357-2267

Interoperability endpoints

  • Direct secure messaging: adam.corneliussen.p1@direct.opaak.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

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": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1821490301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 LAKE OTIS PKWY",
            "address_2": "SUITE 300",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085234",
            "telephone_number": "907-562-2277",
            "fax_number": "907-563-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 LAKE OTIS PKWY",
            "address_2": "SUITE 300",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085234",
            "telephone_number": "907-562-2277",
            "fax_number": "907-563-3460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3125 E Meridian Park Loop Ste 300",
            "address_purpose": "LOCATION",
            "city": "Wasilla",
            "state": "AK",
            "postal_code": "996547528",
            "country_code": "US",
            "telephone_number": "907-562-2277",
            "fax_number": "907-563-3460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNELIUSSEN",
        "first_name": "ADAM",
        "middle_name": "R.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-16",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "104245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1636106",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.