Organization Active NPI

Meade County Pediatrics PLLC

  • Pediatrics Physician
  • Brandenburg, KY
National Provider Identifier
1083854731
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEADE COUNTY PEDIATRICS PLLC
Practice address
1010 Lawrence Street
Brandenburg, KY 40108-1401
Phone
(270) 422-3400
NPI assigned
Feb 20, 2009
Last updated
Jun 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

Name
Robert L. KupperNPI 1134382625
Title
Owner
Phone
(270) 422-3400

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1010 Lawrence Street
Brandenburg, KY 40108-1401

Mailing address

1010 Lawrence Street
Brandenburg, KY 40108-1401
Phone (270) 422-3400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090625000460 KY Part B Supplier - Clinic/Group Practice 3173674520 Practice locations: Brandenburg, KY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1099915Meade County Pediatrics1010 Lawrence Street, Brandenburg, KY 40108Certificate of waiverDec 3, 2027

National Provider Directory

National Provider Directory

Locations

1010 Lawrence St
Brandenburg, KY 40108
Phone (270) 422-3400

Practitioners & affiliated clinicians

Practitioners 5

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": "1235088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1083854731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAWRENCE STREET",
            "city": "BRANDENBURG",
            "state": "KY",
            "postal_code": "401081401",
            "telephone_number": "270-422-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAWRENCE STREET",
            "city": "BRANDENBURG",
            "state": "KY",
            "postal_code": "401081401",
            "telephone_number": "270-422-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADE COUNTY PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-20",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "KUPPER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-422-3400"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandenburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.