NPIMap

Individual provider Active NPI

Paul Christen Pedersen, M.D.

  • General Practice Physician
  • Barbourville, KY
National Provider Identifier
1003892720
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
31705 Issued in KY
Practice address
602 Knox St
Barbourville, KY 40906-1304
Phone
(606) 546-6027
Fax
(606) 546-2084
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 31705 KY Primary

Addresses

Primary practice location

602 Knox St
Barbourville, KY 40906-1304

Mailing address

PO Box 1325
Corbin, KY 40702-1325
Phone (606) 526-8131

Other identifiers 2

IdentifierTypeStateIssuer
64317050MedicaidKY
P01427263OtherKYRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ppedersen4776@bhkydirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20040809000698 KY Practitioner - General Practice 6406835560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

602 Knox St
Barbourville, KY 40906-1304
Phone (606) 546-6027

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

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

Practice roles

OrganizationSpecialtyStatusNew patients
Knox Family Medicine Current Accepting new patients
Baptist Health Medical Group Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

602 Knox St
Barbourville, KY 40906
Phone (606) 546-6027

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

96 Future Dr
Corbin, KY 40701

1 Trillium Way
Ste 301
Corbin, KY 40701
Phone (606) 526-7363

1851 N Main St
Madisonville, KY 42431
Phone (270) 821-7739

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 4

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1003892720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1325",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407021325",
            "telephone_number": "606-526-8131",
            "fax_number": "606-528-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 KNOX ST",
            "city": "BARBOURVILLE",
            "state": "KY",
            "postal_code": "409061304",
            "telephone_number": "606-546-6027",
            "fax_number": "606-546-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "PAUL",
        "middle_name": "CHRISTEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KY",
            "license": "31705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64317050",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01427263",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppedersen4776@bhkydirect.com",
            "affiliation": "N",
            "address_1": "602 Knox St",
            "city": "Barbourville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "409061304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Barbourville, KY

Sources for this page

Verify at the official NPI Registry.