Jackson Tuley Cornelison, is a medicare enrolled "Nurse Practitioner - Acute Care" physician in Birmingham, Alabama. His current practice location is
619 19th St S, Birmingham, Alabama. You can reach out to his office (for appointments etc.) via phone at
(205) 934-4011.
Jackson Tuley Cornelison is licensed to practice in Alabama (license number 1-160696) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154929131.
Physician's Profile
Full Name | Jackson Tuley Cornelison |
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Gender | Male |
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Speciality | Nurse Practitioner - Acute Care |
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Location | 619 19th St S, Birmingham, Alabama |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1154929131
- Provider Enumeration Date: 10/13/2020
- Last Update Date: 06/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 5092126797
- Enrollment ID: I20201202000993
Medical Identifiers
Medical identifiers for Jackson Tuley Cornelison such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1154929131 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 1-160696 (Alabama) | Secondary |
363LA2100X | Nurse Practitioner - Acute Care | 1-160696 (Alabama) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jackson Tuley Cornelison allows following entities to bill medicare on his behalf.
Entity Name | University Of Alabama Health Services Foundation, Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1093768723 PECOS PAC ID: 1951213107 Enrollment ID: O20031105000261 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jackson Tuley Cornelison is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jackson Tuley Cornelison, Po Box 55310, Birmingham, AL 35255-5310 Ph: (205) 731-9701 | Jackson Tuley Cornelison, 619 19th St S, Birmingham, AL 35249-2338 Ph: (205) 934-4011 |
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