NPIMap

Individual provider Active NPI

Kenneth Eric Ruby, MD

  • Urology Physician
  • Somerset, KY
National Provider Identifier
1063419133
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
34707 Issued in KY
Practice address
30 Medpark Square
Suite 1
Somerset, KY 42503-3812
Phone
(606) 677-8360
Fax
(606) 677-8399
NPI assigned
Jul 5, 2005
Last updated
Aug 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 34707 KY Primary

Addresses

Primary practice location

30 Medpark Square
Suite 1
Somerset, KY 42503-3812

Mailing address

30 Medpark Square
Suite 1
Somerset, KY 42503-3812
Phone (606) 677-8360

Other identifiers 1

IdentifierTypeStateIssuer
64347073MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090224000764 KY Practitioner - Urology 8527123694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Texas Medical Branch at Galveston, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

30 Medpark Square Dr
Suite 1
Somerset, KY 42503-1709
Phone (606) 451-0485

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection14
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34707KYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Cumberland Physician Practices LLC CurrentSince Dec 1, 2015 Accepting new patients
Lake Cumberland Physician Practices, LLC Current Accepting new patients
Lake Cumberland Physician Practices, LLC Urology CurrentSince Dec 1, 2015 Accepting new patients
Lake Cumberland Physician Practices LLC Past Accepting new patients

Locations

30 Medpark Square Dr
Ste 1
Somerset, KY 42503
Phone (606) 451-0485

30 Tower Cir
Somerset, KY 42503
Phone (606) 451-8644

301 Langdon St
Somerset, KY 42503
Phone (606) 678-9688

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: kenneth.ruby.1@21269.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376611200000",
    "number": "1063419133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEDPARK SQUARE",
            "address_2": "SUITE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033812",
            "telephone_number": "606-677-8360",
            "fax_number": "606-677-8399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEDPARK SQUARE",
            "address_2": "SUITE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033812",
            "telephone_number": "606-677-8360",
            "fax_number": "606-677-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBY",
        "first_name": "KENNETH",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2013-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "34707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64347073",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerset, KY

Sources for this page

Verify at the official NPI Registry.