NPIMap

Organization Active NPI

Danville Pathology Associates PLLP

  • Anatomic Pathology & Clinical Pathology Physician
  • Danville, KY
National Provider Identifier
1063484756
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
18160 Issued in KY
Legal business name
DANVILLE PATHOLOGY ASSOCIATES PLLP
Practice address
217 S 3Rd St
Danville, KY 40422-1823
Phone
(859) 239-2220
Fax
(859) 239-6732
NPI assigned
Feb 6, 2006
Last updated
Sep 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Authorized official

Name
Dr. Richard G Jackson, M.D.NPI 1023080025
Title
President
Phone
(859) 239-2220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X 28116 KY
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 18160 KY Primary

Addresses

Primary practice location

217 S 3Rd St
Danville, KY 40422-1823

Mailing address

5700 Southwyck Blvd
Toledo, OH 43614-1509
Phone (800) 288-8325

Other practice location 1

110 Metker Trl
Stanford, KY 40484-1020
Phone (606) 365-4600

Other practice location 2

464 Linden Ave
Harrodsburg, KY 40330-1882
Phone (859) 734-5441

Other identifiers 1

IdentifierTypeStateIssuer
65903031MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050927000242 KY Part B Supplier - Clinic/Group Practice 8820022080 Receives reassigned benefits from 2 practitioners
Practice locations: Danville, KY; Stanford, KY; Harrodsburg, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1063484756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S 3RD ST",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404221823",
            "telephone_number": "859-239-2220",
            "fax_number": "859-239-6732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Metker Trl",
            "address_purpose": "LOCATION",
            "city": "Stanford",
            "state": "KY",
            "postal_code": "404841020",
            "country_code": "US",
            "telephone_number": "606-365-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "464 Linden Ave",
            "address_purpose": "LOCATION",
            "city": "Harrodsburg",
            "state": "KY",
            "postal_code": "403301882",
            "country_code": "US",
            "telephone_number": "859-734-5441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DANVILLE PATHOLOGY ASSOCIATES PLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-239-2220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "KY",
            "license": "28116",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "KY",
            "license": "18160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65903031",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.