Active NPI
Geriatric Essentials, PC
- Geriatric Psychiatry Physician
- Mayfield, KY
National Provider Identifier
1043812696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Psychiatry Physician
- Legal business name
- GERIATRIC ESSENTIALS, PC
- Practice address
- 402 W Farthing St
Mayfield, KY 42066-2900 - Phone
- (731) 571-8808
- NPI assigned
- Nov 9, 2020
- Last updated
- Nov 9, 2020
- Organization subpart
- Yes
- Parent organization
- GERIATRIC ESSENTIALS PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan K Lovelace
- Title
- Billing/Credentialing
- Phone
- (731) 410-7719
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Psychiatry Physician | 2084P0805X | Primary |
Addresses
Primary practice location
402 W Farthing St
Mayfield, KY 42066-2900
Mailing address
PO Box 12432
Jackson, TN 38308-0141
Phone (731) 410-7719
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100689200 | Medicaid | KY |
National Provider Directory
National Provider Directory- Part of
- Geriatric Essentials PC
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Other Technician
- Jackson, TN
- NPI 1003267717
-
- Gerontology Nurse Practitioner
- Dyersburg, TN
- NPI 1144490467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1604880000000",
"number": "1043812696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12432",
"city": "JACKSON",
"state": "TN",
"postal_code": "383080141",
"telephone_number": "731-410-7719",
"fax_number": "731-214-1816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 W FARTHING ST",
"city": "MAYFIELD",
"state": "KY",
"postal_code": "420662900",
"telephone_number": "731-571-8808"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GERIATRIC ESSENTIALS, PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GERIATRIC ESSENTIALS PC",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A",
"authorized_official_last_name": "LOVELACE",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "BILLING/CREDENTIALING",
"authorized_official_telephone_number": "731-410-7719"
},
"taxonomies": [
{
"code": "2084P0805X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Geriatric Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100689200",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mayfield, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.