Active NPI
Ronald B Elder, M.D., PSC
- Pediatrics Physician
- Russellville, KY
National Provider Identifier
1043217169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 34620
- Practice address
- 1623 Nashville St
Suite 201
Russellville, KY 42276-8889 - Phone
- (270) 726-3303
- Fax
- (270) 726-3910
- NPI assigned
- Jul 5, 2005
- Last updated
- Jun 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 34620 | KY | Primary |
Addresses
Primary practice location
1623 Nashville St
Suite 201
Russellville, KY 42276-8889
Mailing address
1623 Nashville St
Suite 201
Russellville, KY 42276-8889
Phone (270) 726-3303
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1010779800001 | Medicaid | PA | |
| 611349692 | Other | KY | HUMANA |
| 611349692 | Other | KY | UNITED HEALTH CARE |
| 64346208 | Medicaid | KY | |
| 000000065383 | Other | KY | ANTHEM |
| 611349692 | Other | KY | CHA |
| 611349692 | Other | KY | RESERVE NATIONAL |
| 611349692 | Other | KY | UNITED HEALTH CARE - RAIL |
| 2364418006 | Other | KY | CIGNA |
| 23J8 | Other | KY | ANTHEM FEP |
| 48417 | Other | KY | PHCS |
| 611349692 | Other | KY | CENTER CARE |
| 611349692 | Other | KY | NATIONAL TELEPHONE COOPER |
| 5076198 | Other | KY | AETNA US HEALTHCARE (MC) |
| 1631299 | Other | KY | FIRST HEALTH NETWORK |
| 611349692 | Other | KY | MISCELLANEOUS COMMERCIAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34620 | KY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401926400000",
"number": "1043217169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1623 NASHVILLE ST",
"address_2": "SUITE 201",
"city": "RUSSELLVILLE",
"state": "KY",
"postal_code": "422768889",
"telephone_number": "270-726-3303",
"fax_number": "270-726-3910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1623 NASHVILLE ST",
"address_2": "SUITE 201",
"city": "RUSSELLVILLE",
"state": "KY",
"postal_code": "422768889",
"telephone_number": "270-726-3303",
"fax_number": "270-726-3910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDER",
"first_name": "RONALD",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D., PSC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-05",
"last_updated": "2014-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KY",
"license": "34620",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1010779800001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "611349692",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64346208",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000065383",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHA",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESERVE NATIONAL",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE - RAIL",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2364418006",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM FEP",
"identifier": "23J8",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "48417",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CENTER CARE",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL TELEPHONE COOPER",
"identifier": "611349692",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE (MC)",
"identifier": "5076198",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH NETWORK",
"identifier": "1631299",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISCELLANEOUS COMMERCIAL",
"identifier": "611349692",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.