NPIMap

Organization Active NPI

Kentucky Mso LLC

Doing business as Gastroenterology and Hepatology of the Bluegrass

  • Gastroenterology Physician
  • Georgetown, KY
National Provider Identifier
1164867883
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
KENTUCKY MSO LLC
Doing business as
Gastroenterology and Hepatology of the Bluegrass
Practice address
1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672
Phone
(502) 570-3721
Fax
(502) 570-3722
NPI assigned
May 8, 2013
Last updated
Apr 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Monica Bowman
Title
Corporate Secretary
Phone
(615) 920-7000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672

Mailing address

1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672
Phone (502) 570-3721

Other practice location 1

138 Professional Ave
Winchester, KY 40391-1116
Phone (505) 570-3751

Other names 1

  • Gastroenterology and Hepatology of the Bluegrass Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110901000380 KY Part B Supplier - Clinic/Group Practice 0749450633 Receives reassigned benefits from 104 practitioners
11 other NPIs on this enrollment
Practice locations: Versailles, KY; Paris, KY; Mount Sterling, KY; West Liberty, KY; Winchester, KY; Georgetown, KY; Lawrencburg, KY; Lawrenceburg, KY…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Kentucky Mso LLC

    dba Centerpoint Family Medicine - Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, KY
    • NPI 1922860758

    0749450633

    Same PAC ID

Other NPIs on the same Medicare enrollment 11

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

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
18D2151317Gastroenterology and Hepatology of the Bluegrass1138 Lexington Rd, Suite 140, Georgetown, KY 40324Certificate of waiverOct 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bluegrass Family Care Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

370 Amsden Ave
Ste 501
Versailles, KY 40383
Phone (859) 873-5011

138 Professional Ave
Winchester, KY 40391
Phone (859) 497-1036

Practitioners & affiliated clinicians

Practitioners 106

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 106

NPI Registry JSON

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1164867883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 LEXINGTON RD",
            "address_2": "SUITE 140",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249672",
            "telephone_number": "502-570-3721",
            "fax_number": "502-570-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 LEXINGTON RD",
            "address_2": "SUITE 140",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249672",
            "telephone_number": "502-570-3721",
            "fax_number": "502-570-3722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "138 Professional Ave",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "KY",
            "postal_code": "403911116",
            "country_code": "US",
            "telephone_number": "505-570-3751",
            "fax_number": "505-570-3722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENTUCKY MSO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gastroenterology and Hepatology of the Bluegrass",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gastroenterology and Hepatology of the Bluegrass",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.