NPIMap

Organization Active NPI

Assuredlink Case Management Agency

  • Private Vehicle
  • Bowling Green, KY
National Provider Identifier
1205267671
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Private VehicleTaxonomy code 347C00000X
License
K12245600 Issued in KY
Legal business name
ASSUREDLINK CASE MANAGEMENT AGENCY
Practice address
1990 Louisville Rd
101
Bowling Green, KY 42101-1202
Phone
(270) 599-0212
NPI assigned
Dec 10, 2013
Last updated
Mar 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Authorized official

Name
Ms. Demetrius Depp King, E.D.NPI 1093255499
Title
Owner/ Executive Director
Phone
(270) 303-4669

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 7100347620 KY
Private Vehicle 347C00000X K12245600 KY Primary
Professional Counselor 101YP2500X 171431 KY

Addresses

Primary practice location

1990 Louisville Rd
101
Bowling Green, KY 42101-1202

Mailing address

1990 Louisville Rd
101
Bowling Green, KY 42101-1202
Phone (270) 599-0212

Other identifiers 3

IdentifierTypeStateIssuer
7100224880MedicaidKY
7100438780MedicaidKY
7100347620MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Demetrius King2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1733 Campus Plaza Ct
Ste 6
Bowling Green, KY 42101

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1205267671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 LOUISVILLE RD",
            "address_2": "101",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011202",
            "telephone_number": "270-599-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 LOUISVILLE RD",
            "address_2": "101",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011202",
            "telephone_number": "270-599-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSUREDLINK CASE MANAGEMENT AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "DEMETRIUS",
        "authorized_official_middle_name": "DEPP",
        "authorized_official_title_or_position": "OWNER/ EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "270-303-4669",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "E.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "KY",
            "license": "7100347620",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "KY",
            "license": "K12245600",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "171431",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100224880",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100438780",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100347620",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.