NPIMap

Individual provider Active NPI

Ron E Creque Jr., MD

  • Family Medicine Physician
  • Shelbyville, KY
National Provider Identifier
1194717397
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36516 Issued in KY
Practice address
101 Stonecrest Road
Suite 3
Shelbyville, KY 40065
Phone
(502) 633-5565
Fax
(502) 633-5154
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36516 KY Primary

Addresses

Primary practice location

101 Stonecrest Road
Suite 3
Shelbyville, KY 40065

Mailing address

101 Stonecrest Road
Suite 3
Shelbyville, KY 40065
Phone (502) 633-5565

Other identifiers 2

IdentifierTypeStateIssuer
000000200138OtherANTHEM
64030653MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20061106000495 KY Practitioner - Family Practice 5092712901 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stonecrest Family Medicine PLLCGroup PAC ID 4284631193, 5 clinicians
PT Pros, IncGroup PAC ID 0143139337, shared by 14 NPIs, 263 clinicians

Practice addresses (Care Compare)

101 Stonecrest Rd
Suite 3
Louisville, KY 40065-8169

4031 N Dixie Hwy
Suite 104
Elizabethtown, KY 42701-7873
Phone (270) 982-4776

Hospital & facility affiliations

  • Caretenders Home health agency, Louisville, KY, CCN 187152
  • Centerwell Home Health Home health agency, Louisville, KY, CCN 187090
  • Vna Health at Home Home health agency, Louisville, KY, CCN 187000
  • Uofl Health - Shelbyville Hospital Hospital, Shelbyville, KY, CCN 180016
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Baptist Health Lagrange Hospital, La Grange, KY, CCN 180138
  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36516KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince May 30, 2014 Accepting new patients
Stonecrest Family Medicine PLLC CurrentSince Mar 13, 2006 Accepting new patients
Baptist Health Medical Group Inc CurrentSince May 30, 2014 Accepting new patients

Locations

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

101 Stonecrest Rd
Ste 3
Shelbyville, KY 40065
Phone (502) 633-5565

101 Stonecrest Rd
Ste 1
Shelbyville, KY 40065
Phone (502) 633-2233

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: rcreque6464@bhkydirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194717397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 STONECREST ROAD",
            "address_2": "SUITE 3",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "40065",
            "telephone_number": "502-633-5565",
            "fax_number": "502-633-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 STONECREST ROAD",
            "address_2": "SUITE 3",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "40065",
            "telephone_number": "502-633-5565",
            "fax_number": "502-633-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREQUE",
        "first_name": "RON",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "36516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000200138",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64030653",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, KY

Sources for this page

Verify at the official NPI Registry.