NPIMap

Organization Active NPI

Physicians Health Group of Kentucky, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Louisville, KY
National Provider Identifier
1104343490
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PHYSICIANS HEALTH GROUP OF KENTUCKY, PLLC
Practice address
950 Breckenridge LN Ste 20
Louisville, KY 40207-5931
Phone
(859) 687-9456
NPI assigned
Aug 28, 2017
Last updated
Feb 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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

Authorized official

Name
John Rush, MDNPI 1851337281
Title
Authorized Official
Phone
(301) 928-1697

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Physical Medicine & Rehabilitation Physician 208100000X NU

Addresses

Primary practice location

950 Breckenridge LN Ste 20
Louisville, KY 40207-5931

Mailing address

950 Breckenridge LN Ste 20
Louisville, KY 40207-5931

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141210002551 KY Part B Supplier - Clinic/Group Practice 4385966894 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lexington, KY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1104343490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 BRECKENRIDGE LN STE 20",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402075931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 BRECKENRIDGE LN STE 20",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402075931",
            "telephone_number": "859-687-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS HEALTH GROUP OF KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "301-928-1697",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.