NPIMap

Individual provider Active NPI

Amber Lyn Daugherty, MD

  • Family Medicine Physician
  • Mount Verono, OH
National Provider Identifier
1124273875
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.095036 Issued in OH
Practice address
1330 Coshocton Ave
Mount Verono, OH 43050
Phone
(740) 393-9000
Fax
(740) 392-0167
NPI assigned
Nov 21, 2008
Last updated
Feb 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35095036 OH
Family Medicine Physician 207Q00000X 35.095036 OH Primary

Addresses

Primary practice location

1330 Coshocton Ave
Mount Verono, OH 43050

Mailing address

1330 Coshocton Ave
Mount Verono, OH 43050
Phone (740) 393-9000

Other identifiers 1

IdentifierTypeStateIssuer
H016920OtherOHMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20110719000844 OH Practitioner - Family Practice 4789852641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Knox Community HospitalGroup PAC ID 1153301833, 117 clinicians

Practice addresses (Care Compare)

1330 Coshocton Ave
Mount Vernon, OH 43050-1440

16361 Village Pkwy
Fredericktown, OH 43019-9585
Phone (740) 399-3863

307 Vernedale Dr
Mount Vernon, OH 43050-2921

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.095036OHMDFamily Medicine Physician
35095036OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Knox Community Hospital CurrentSince Jul 1, 2011 Accepting new patients
Knox Community Hospital Family Medicine CurrentSince Jul 1, 2011 Accepting new patients

Locations

16361 Village Pkwy
Fredericktown, OH 43019
Phone (614) 392-7075

1330 Coshocton Ave
Mount Vernon, OH 43050
Phone (740) 393-9019

1330 Coshocton Ave
Fl 5
Mount Vernon, OH 43050
Phone (740) 393-9040

Interoperability endpoints

  • Direct secure messaging: amberdaugherty@kch.allscriptsdirect.net

Organizations & group practices 2

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 7

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": "1227225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1124273875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 COSHOCTON AVE",
            "city": "MOUNT VERONO",
            "state": "OH",
            "postal_code": "43050",
            "telephone_number": "740-393-9000",
            "fax_number": "740-392-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 COSHOCTON AVE",
            "city": "MOUNT VERONO",
            "state": "OH",
            "postal_code": "43050",
            "telephone_number": "740-393-9000",
            "fax_number": "740-392-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "AMBER",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-21",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35095036",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.095036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H016920",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.