Gary Bodnarchuk, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

28275 Issued in KY

Practice address

1532 Lone Oak Rd
Suite 310
Paducah, KY 42003-7913

Phone

(270) 443-0777

Fax

(270) 443-0999

NPI assigned

Dec 29, 2005

Last updated

Jun 8, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mercy Health Physicians Kentucky Specialty Care LLC

  • Surgery Physician
  • Paducah, KY
  • NPI 1700408093
  Medicare reassignment NPD
• Paducah Gastroenterology Associates, PSC

  • Gastroenterology Physician
  • Paducah, KY
  • NPI 1568601672
  NPD (past) Authorized official
• Mercy Health Physicians Kentucky Specialty Care LLC

  dba Mercy Health - Paducah Orthopedics

  • Durable Medical Equipment & Medical Supplies
  • Paducah, KY
  • NPI 1043088347
  NPD
• Paducah Gastroenterology Associates, PSC

  • Specialist
  • Paducah, KY
  • NPI 1417986191
  NPD (past)
• Western Baptist Medical Ventures, Inc.

  dba Paducah Neurosurgical Center

  • Neurological Surgery Physician
  • Paducah, KY
  • NPI 1316017080
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1033196084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636961",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636961",
            "telephone_number": "513-981-5130",
            "fax_number": "513-981-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 LONE OAK RD",
            "address_2": "SUITE 310",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037913",
            "telephone_number": "270-443-0777",
            "fax_number": "270-443-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODNARCHUK",
        "first_name": "GARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "KY",
            "license": "28275",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036.075177",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00947881",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64282759",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036075177",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bluegrass Pediatrics, LLC
• Kenny L Boaz
• Andre' Tyrone Bobo, M.D.
• Elizabeth Ann Bobo
• Brian R. Bodnarchuk, MD
• Blayne Allyssa Bogard
• Sarah Bogard
• Kevin Lee Boggess, LCSW
• Anthony L Bohannon, PT
• Michelle Bohanon, RPH, BCPS

• Gastroenterology Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Gastroenterology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.