Individual provider Active NPI

Timothy James Egan, PA

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1033779269
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2546 Issued in KY
Practice address
800 Rose St
Room M53
Lexington, KY 40536-0298
Phone
(859) 323-5908
Fax
(859) 323-8056
NPI assigned
Jun 19, 2019
Last updated
Aug 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2546 KY
Surgical Physician Assistant 363AS0400X PA2546 KY
Physician Assistant 363A00000X PA2546 KY Primary

Addresses

Primary practice location

800 Rose St
Room M53
Lexington, KY 40536-0298

Mailing address

800 Rose St RM M53
Lexington, KY 40536-0298
Phone (859) 323-5908

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
58315CAMDPharmacist
PA2546KYMDSurgical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597622400000",
    "number": "1033779269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROSE ST RM M53",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360298",
            "telephone_number": "859-323-5908",
            "fax_number": "859-323-8056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROSE ST",
            "address_2": "ROOM M53",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360298",
            "telephone_number": "859-323-5908",
            "fax_number": "859-323-8056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGAN",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-19",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA2546",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA2546",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.