NPIMap

Organization Active NPI

Owensboro Health Medical Group, Inc

Doing business as Owensboro Health Madisonville Healthplex

  • Clinical Medical Laboratory
  • Madisonville, KY
National Provider Identifier
1043343536
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
200235 Issued in KY
Legal business name
OWENSBORO HEALTH MEDICAL GROUP, INC
Doing business as
Owensboro Health Madisonville Healthplex
Owensboro Health Medical Group - MultiCare
Practice address
510 Ruby Dr
Madisonville, KY 42431-2168
Phone
(270) 399-7900
Fax
(270) 399-7910
NPI assigned
Mar 13, 2007
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
OWENSBORO HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Authorized official

Name
Mr. Russell S Ranallo
Title
Secretary
Phone
(270) 417-4813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 200235 KY Primary

Addresses

Primary practice location

510 Ruby Dr
Madisonville, KY 42431-2168

Mailing address

PO Box 23229
Owensboro, KY 42304-3229
Phone (270) 688-1330

Other identifiers 1

IdentifierTypeStateIssuer
200235OtherKYSTATE LICENSURE NUMBER

Other names 2

  • Owensboro Health Madisonville Healthplex Doing business as
  • Owensboro Health Medical Group - MultiCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070716000700 KY Part B Supplier - Independent Clinical Laboratory 0648255034 1 other NPI on this enrollment
Practice locations: Madisonville, KY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0909292Owensboro Health Madisonville Healthplex510 Ruby Drive, Madisonville, KY 42431ComplianceApr 18, 2028
18D2062897Owensboro Health Madisonville Healthplex510 Ruby Drive, Madisonville, KY 42431Certificate of waiverJul 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mohammed Kaleemuddin MD74 organizations share this tax ID, including this one
Part of
Owensboro Health Outpatient

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

440 Hopkinsville St
Ste 2E
Greenville, KY 42345
Phone (270) 338-8000

1201 Pleasant Valley Rd
Fl 3
Owensboro, KY 42303
Phone (270) 417-5390

1325 Triplett St
#A
Owensboro, KY 42303
Phone (270) 686-8500

811 E Parrish Ave
Ste 101
Owensboro, KY 42303
Phone (270) 684-1145

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1043343536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 RUBY DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424312168",
            "telephone_number": "270-399-7900",
            "fax_number": "270-399-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENSBORO HEALTH MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OWENSBORO HEALTH INC",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "RANALLO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "270-417-4813",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": "200235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE NUMBER",
            "identifier": "200235",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owensboro Health Madisonville Healthplex",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Owensboro Health Madisonville Healthplex",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Owensboro Health Medical Group - MultiCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madisonville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.