Individual provider Active NPI

Jason R Cornelius, MD

  • Neurology Physician
  • Maple Grove, MN
National Provider Identifier
1982610739
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
48590 Issued in MN
Practice address
9645 Grove Cir N Ste 100
Maple Grove, MN 55369
Phone
(763) 302-4114
Fax
(763) 302-4081
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X 48590 MN
Neurology Physician 2084N0400X 48590 MN Primary

Addresses

Primary practice location

9645 Grove Cir N Ste 100
Maple Grove, MN 55369

Mailing address

9645 Grove Cir N Ste 100
Maple Grove, MN 55369-4466
Phone (763) 302-4114

Other identifiers 2

IdentifierTypeStateIssuer
1982610739MedicaidMN
P00733589OtherMNMEDICARE RAILROAD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcornelius13061@direct.northmemorial.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060907000535 MN Practitioner - NeurologyPractitioner - Sleep Medicine 7719981620 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Sleep Medicine
Education
University of Maryland School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians

Practice addresses (Care Compare)

13800 83Rd Way N
Suite 102
Maple Grove, MN 55369-7016
Phone (763) 581-5050

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

9645 Grove Cir N
Suite 100
Maple Grove, MN 55369-4466
Phone (763) 302-4114

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
83.94

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince Mar 26, 2017 Accepting new patients
Minneapolis Clinic of Neurology, LTD Neurology CurrentSince Jul 12, 2010 Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

13800 83rd Way N
Ste 102
Maple Grove, MN 55369
Phone (763) 398-4400

9645 Grove Cir N
Ste 100
Maple Grove, MN 55369
Phone (763) 302-4114

4225 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0661

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

1687 E Division St
River Falls, WI 54022
Phone (715) 425-6701

Organizations & group practices 3

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 5

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1982610739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694466",
            "telephone_number": "763-302-4114",
            "fax_number": "763-302-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-302-4114",
            "fax_number": "763-302-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "JASON",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "MN",
            "license": "48590",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "48590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982610739",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00733589",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcornelius13061@direct.northmemorial.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "9645 Grove Cir N Ste 100",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.