JUAN ALFARO CORNEJO, CSFA — NPI 1205611845 (Licensed & Credentialed Specialist/Technologist, Other, Surgical Assistant in TYLER, TX)

CMS-1500 Box 24J / 33a • NPI

1205611845

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

246ZC0007X

Licensed & Credentialed Specialist/Technologist, Other, Surgical Assistant

Box 32 Service Location & ZIP+4

828 S FLEISHEL AVE, TYLER, TX, 75701-2042

✓ 9-Digit EDI 837 ZIP+4 (75701-2042)

Practice Phone & Referral Fax

(903) 646-5350

Fax: (888) 501-1092

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205611845 (JUAN ALFARO CORNEJO, CSFA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1205611845` (NPI-1 Individual Practitioner)
Provider / Legal Name	JUAN ALFARO CORNEJO, CSFA
Plain-English Specialty	Licensed & Credentialed Specialist/Technologist, Other, Surgical Assistant NUCC Code: `246ZC0007X` (Specialist/Technologist, Other, Surgical Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	828 S FLEISHEL AVE, TYLER, TX, 75701-2042
Practice Telephone / Fax	Tel: (903) 646-5350 \| Fax: (888) 501-1092
Administrative Mailing Address	113 THUNDERBIRD DR, ATHENS, TX, 75751-3509
Enumeration & Last Sync	Enumerated: 2023-08-30 \| CMS Record Updated: 2023-08-30

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

828 S FLEISHEL AVE, TYLER, TX, 75701-2042

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Plain-English Taxonomy & CMS Crosswalk (246ZC0007X)

What Does Taxonomy Code 246ZC0007X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 246ZC0007X translates to:
"Licensed & Credentialed Specialist/Technologist, Other, Surgical Assistant"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Specialist/Technologist, Other, Surgical Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JUAN ALFARO CORNEJO, CSFA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`246ZC0007X` — Specialist/Technologist, Other, Surgical Assistant Plain English: Licensed & Credentialed Specialist/Technologist, Other, Surgical Assistant	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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JUAN ALFARO CORNEJO, CSFA (NPI #1205611845)