Individual provider Active NPI

Douglas Wayne Becker, N.P.

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1184879736
Registry record updated Dec 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3003519 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-2000
Fax
(859) 301-6910
NPI assigned
Nov 24, 2008
Last updated
Dec 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3003519 KY Primary
Nurse Practitioner 363L00000X 71001655A IN
Nurse Practitioner 363L00000X 10395 OH
Family Nurse Practitioner 363LF0000X 10395 OH

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-6160

Other practice location 1

8251 Pine Rd
Ste 220
Cincinnati, OH 45236-2191
Phone (513) 936-9191

Other practice location 2

350 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 426-0800

Other identifiers 3

IdentifierTypeStateIssuer
78006475MedicaidKY
611300608056OtherOHCARESOURCE
P00873403OtherOHRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100812000588 KY Practitioner - Nurse Practitioner 1355406380 Reassigns benefits to 2 organizations
I20240705002170 IN Practitioner - Nurse Practitioner 1355406380 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Elizabeth Medical Center, IncGroup PAC ID 0648174623, 187 clinicians
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-2237

600 Wilson Creek Rd
Lawrenceburg, IN 47025-2751
Phone (859) 301-2465

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10395OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeth Medical Center, Inc CurrentSince Dec 21, 2025 Accepting new patients
Summit Medical Group, Inc Nurse Practitioner Current Accepting new patients
St Elizabeth Medical Center, Inc Nurse Practitioner CurrentSince Dec 21, 2025 Accepting new patients
Comprehensive Cardiology Cons Inc Past Accepting new patients

Locations

204 Bridgeway St
Aurora, IN 47001
Phone (812) 926-3133

600 Wilson Creek Rd
Lawrenceburg, IN 47025
Phone (812) 532-2700

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

350 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (513) 569-5200

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

8251 Pine Rd
Ste 220
Cincinnati, OH 45236
Phone (513) 246-4550

Interoperability endpoints

  • Direct secure messaging: dbecker82669@direct-prd.stelizabeth.com

Organizations & group practices 5

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 2

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": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1184879736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-6160",
            "fax_number": "859-301-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-2000",
            "fax_number": "859-301-6910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8251 Pine Rd",
            "address_2": "Ste 220",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452362191",
            "country_code": "US",
            "telephone_number": "513-936-9191",
            "fax_number": "513-936-0222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 Thomas More Pkwy",
            "address_purpose": "LOCATION",
            "city": "Crestview Hills",
            "state": "KY",
            "postal_code": "41017",
            "country_code": "US",
            "telephone_number": "859-426-0800",
            "fax_number": "859-426-4140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BECKER",
        "first_name": "DOUGLAS",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-24",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3003519",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001655A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "10395",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "10395",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78006475",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "611300608056",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00873403",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.