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ANNIE KATHRYN KORNETZKE DO
NPI 1053979948
Family Medicine in Taylorsville, UT

Active since June 05, 2019PECOS EnrolledAccepts Medicare Assignment
4745 S 3200 W, TAYLORSVILLE, UT 84129(801) 964-6214(877) 497-4661 Get Directions Write a Review

NPPES record last updated: July 19, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 19, 2022, Jun 5, 2019 (2 updates tracked since 2019).

About Annie Kathryn Kornetzke Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANNIE KATHRYN KORNETZKE DO (NPI 1053979948) is an individual family medicine provider in Taylorsville, Utah, licensed in Utah (12784879-1204) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS and is a graduate of Chicago College Of Osteopathy (2019).

NPPES Registry Identity

NPI1053979948
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameANNIE KATHRYN KORNETZKECredential: DO
Location Address4745 S 3200 WTaylorsville, UT 84129-2822
Mailing Address2621 S 3270 WTaylorsville, UT 84119-1119 · (385) 261-2614 · Fax (877) 497-4661
Phone(801) 964-6214
Fax(877) 497-4661
Sole ProprietorNo
Medical School CMSChicago College Of OsteopathyGraduated 2019
Enumeration DateJune 5, 2019
Last NPPES UpdateJuly 19, 20222 updates tracked since enumeration
NPPES CertifiedJuly 19, 2022
✔ NPI 1053979948 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in UT · 12784879-1204
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 125074527 (IL)
4745 S 3200 W, Taylorsville, UT 84129
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Annie Kathryn Kornetzke Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6002244944
PECOS Enrollment IDI20220823000564
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Annie Kornetzke reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Community Health Centers, Inc.
Same address
Federally Qualified Health Center (FQHC)
4745 S 3200 W
Taylorsville, UT 84129
  • Reassigned Medicare billing, Utah enrollment
  • 59 clinicians in this Medicare group
NPI 1801992953 (801) 964-6214

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84129 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMBER SHARP HEISE MD
Pediatrics
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (801) 964-6124
ZORICA ANDREA LJUBIC MD
Family Medicine
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (019) 646-2148
MS. JAMILIETH CAMPOS ALEJANDRE
Student in an Organized Health Care Education/Training Program
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (801) 964-6214
DR. ANDREW SORENSEN DO
Student in an Organized Health Care Education/Training Program
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (801) 328-4045
DR. LILLIAN ELIZABETH HAYES MD
Family Medicine
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (801) 964-6214
PAIGE HOLBROOK
Dentist (Dental Public Health)
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (801) 964-6214
MARIA DALIA GARZA
Counselor (Mental Health)
4745 S 3200 W
SALT LAKE CITY, UT 84129
Salt Lake County (801) 964-6214
KRYSTAL G BRAMWELL MD
Family Medicine
4745 S 3200 W
TAYLORSVILLE, UT 84129
Salt Lake County (019) 646-2148

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Annie Kornetzke's NPI number?

The NPI number for Annie Kornetzke is 1053979948. It was assigned to this individual provider in the NPPES registry on June 5, 2019.

Where is Annie Kornetzke located?

Annie Kornetzke practices at 4745 S 3200 W, Taylorsville, UT 84129. The listed phone number is (801) 964-6214.

What is Annie Kornetzke's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Annie Kornetzke enrolled in Medicare?

Yes. Annie Kornetzke is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Annie Kornetzke's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Annie Kornetzke reassigns Medicare benefits to Community Health Centers, Inc. (Taylorsville, UT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Annie Kornetzke's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Annie Kornetzke accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah, Select Health and University of Utah Health Plans list Annie Kornetzke as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Annie Kornetzke was last updated on July 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.