NPIMap

Individual provider Active NPI

Matthew Justice Kornegay Jr., MD

  • Pediatrics Physician
  • Charleston, SC
National Provider Identifier
1922042654
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
31144 Issued in SC
Practice address
1483 Tobias Gadson Blvd Ste 101
Charleston, SC 29407-4795
Phone
(843) 405-1110
Fax
(855) 654-2149
NPI assigned
Jun 15, 2006
Last updated
Sep 19, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 31144 SC
Pediatrics Physician 208000000X 31144 SC Primary

Addresses

Primary practice location

1483 Tobias Gadson Blvd Ste 101
Charleston, SC 29407-4795

Mailing address

1483 Tobias Gadson Blvd Ste 101
Charleston, SC 29407-4795

Other identifiers 2

IdentifierTypeStateIssuer
P00834834OtherSCRAILROAD MEDICARE ID-RSFPN
311442MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20081112000080 SC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 9032113485 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Medical University of South Carolina College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1483 Tobias Gadson Blvd
Suite 101
Charleston, SC 29407-4795
Phone (843) 405-1110

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31144SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Pediatrics CurrentSince Aug 1, 2022 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
Roper Saint Francis Physicians Network Current Accepting new patients
Liberty Doctors, LLC CurrentSince Jun 1, 2023 Accepting new patients
Liberty Doctors LLC Pediatrics CurrentSince Jun 1, 2023 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Sep 1, 2009 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Sep 1, 2009 Accepting new patients
University Medical Associates of the Medical University of South Carol Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Lowcountry Medical Associates Internal Medicine Past Accepting new patients

Locations

1483 Tobias Gadson Blvd
Ste 101
Charleston, SC 29407
Phone (843) 405-1110

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

1871 Savage Rd
Charleston, SC 29407
Phone (843) 766-6308

2270 Ashley Crossing Dr
Ste 110
Charleston, SC 29414
Phone (843) 769-2000

418 Folly Rd
#A
Charleston, SC 29412
Phone (843) 225-8320

2075 Eagle Landing Blvd
North Charleston, SC 29406
Phone (843) 797-5747

Interoperability endpoints

  • Direct secure messaging: matthew.kornegay.1@33527.direct.athenahealth.com
  • Direct secure messaging: mkornegay24626@direct.musc.edu

Organizations & group practices 10

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.

Hospital & facility affiliations 7

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1922042654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD STE 101",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD STE 101",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074795",
            "telephone_number": "843-405-1110",
            "fax_number": "855-654-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNEGAY",
        "first_name": "MATTHEW",
        "middle_name": "JUSTICE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "31144",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "31144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID-RSFPN",
            "identifier": "P00834834",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311442",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294254795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.