NPIMap

Organization Active NPI

Pediatric Products, LLC

  • Durable Medical Equipment & Medical Supplies
  • Shelbyville, KY
National Provider Identifier
1053546804
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PEDIATRIC PRODUCTS, LLC
Practice address
1016 Mount Vernon Drive
Suite 1
Shelbyville, KY 40065-7828
Phone
(502) 633-2006
Fax
(513) 891-4654
NPI assigned
May 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Randy Paulson
Title
Ceo
Phone
(513) 891-4633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1016 Mount Vernon Drive
Suite 1
Shelbyville, KY 40065-7828

Mailing address

2975 Exon Ave
Cincinnati, OH 45241-2520
Phone (513) 891-4633

Other identifiers 1

IdentifierTypeStateIssuer
7100789130MedicaidKY

Other names 1

  • Xpress Nebs Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930041877 KY DME Supplier - Medical Supply Company 3274744487 Practice locations: Shelbyville, KY

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

1016 Mount Vernon Dr
Ste 1
Shelbyville, KY 40065
Phone (502) 633-2006

NPI Registry JSON

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

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1053546804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 EXON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412520",
            "telephone_number": "513-891-4633",
            "fax_number": "513-891-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 MOUNT VERNON DRIVE",
            "address_2": "SUITE 1",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400657828",
            "telephone_number": "502-633-2006",
            "fax_number": "513-891-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PRODUCTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-22",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "PAULSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "513-891-4633"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100789130",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Xpress Nebs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Xpress Nebs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelbyville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.