Individual provider Active NPI

Derrick Wayne Scoggins, APRN

  • Nurse Practitioner
  • Bowling Green, KY
National Provider Identifier
1053980540
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3016140 Issued in KY
Practice address
201 Park St
Bowling Green, KY 42101-1708
Phone
(270) 783-3362
Fax
(270) 780-0472
NPI assigned
Jun 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3016140 KY Primary
Family Nurse Practitioner 363LF0000X 3016140 KY

Addresses

Primary practice location

201 Park St
Bowling Green, KY 42101-1708

Mailing address

201 Park St
Bowling Green, KY 42101-1708
Phone (270) 781-5111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210816003971 KY Practitioner - Nurse Practitioner 7911302872 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

250 Park St
Bowling Green, KY 42101-1795
Phone (270) 745-1000

Hospital & facility affiliations

  • The Medical Center (Bowling Green) Hospital, Bowling Green, KY, CCN 180013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3016140KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Nurse Practitioner CurrentSince Aug 23, 2023 Accepting new patients
Graves Gilbert Clinic PLLC Nurse Practitioner CurrentSince Sep 1, 2021 Accepting new patients
Graves Gilbert Clinic PLLC CurrentSince Sep 1, 2021 Accepting new patients

Locations

6807 Louisville Rd
Bowling Green, KY 42101
Phone (270) 597-3757

5796 Nashville Rd
Bowling Green, KY 42101
Phone (270) 745-0987

2724 Nashville Rd
Bowling Green, KY 42101
Phone (270) 780-0560

1225 Fairway St
Bowling Green, KY 42103
Phone (270) 781-3910

5575 Scottsville Rd
Bowling Green, KY 42104
Phone (270) 282-7088

201 Park St
Bowling Green, KY 42101
Phone (270) 651-2229

250 Park St
Bowling Green, KY 42101
Phone (270) 745-1000

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

1112 S Main St
Franklin, KY 42134
Phone (270) 586-1969

405 S L Rogers Wells Blvd
Glasgow, KY 42141
Phone (270) 479-0260

910 Wallace Ave
Leitchfield, KY 42754
Phone (270) 259-3035

Interoperability endpoints

  • Direct secure messaging: derrickscoggins@ggc.allscriptsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1053980540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011708",
            "telephone_number": "270-781-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011708",
            "telephone_number": "270-783-3362",
            "fax_number": "270-780-0472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOGGINS",
        "first_name": "DERRICK",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-21",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3016140",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3016140",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.