NPIMap

Organization Active NPI

Owensboro Health Medical Group, Inc.

Doing business as Owensboro Health Medical Group - Cardiology

  • Cardiovascular Disease Physician
  • Owensboro, KY
National Provider Identifier
1053810036
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
OWENSBORO HEALTH MEDICAL GROUP, INC.
Doing business as
Owensboro Health Medical Group - Cardiology
Practice address
1201 Pleasant Valley Rd
Owensboro, KY 42303-9811
Phone
(270) 417-7500
Fax
(270) 417-7509
NPI assigned
Feb 6, 2018
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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X KY
Cardiovascular Disease Physician 207RC0000X KY Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X KY
Interventional Cardiology Physician 207RI0011X KY

Addresses

Primary practice location

1201 Pleasant Valley Rd
Owensboro, KY 42303-9811

Mailing address

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

Other practice location 1

2200 E Parrish Ave Bldg D
Owensboro, KY 42303-1458
Phone (270) 417-7500

Other practice location 2

1000 Breckenridge St Ste 101
Owensboro, KY 42303-0840
Phone (270) 417-7500

Other practice location 3

1006 Ford Ave
Owensboro, KY 42301-4677
Phone (270) 417-7500

Other names 1

  • Owensboro Health Medical Group - Cardiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621000818 KY Part B Supplier - Clinic/Group Practice 0648255034 Receives reassigned benefits from 677 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

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

Organizations with this tax ID in the same state 18

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

View all 18

Locations

1000 Breckenridge St
Ste 101
Owensboro, KY 42303
Phone (270) 417-7500

Practitioners & affiliated clinicians

Practitioners 4

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": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1053810036",
    "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": "270-688-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 PLEASANT VALLEY RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423039811",
            "telephone_number": "270-417-7500",
            "fax_number": "270-417-7509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 E Parrish Ave Bldg D",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423031458",
            "country_code": "US",
            "telephone_number": "270-417-7500",
            "fax_number": "270-417-7509",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Breckenridge St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423030840",
            "country_code": "US",
            "telephone_number": "270-417-7500",
            "fax_number": "270-417-7509",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1006 Ford Ave",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423014677",
            "country_code": "US",
            "telephone_number": "270-417-7500",
            "fax_number": "270-417-7509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OWENSBORO HEALTH MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OWENSBORO HEALTH, INC",
        "enumeration_date": "2018-02-06",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owensboro Health Medical Group - Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Owensboro Health Medical Group - Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owensboro, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.