Individual provider Active NPI

Gerald W. Elliott, M.D.

  • Dermatology Physician
  • Lexington, KY
National Provider Identifier
1225063175
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
26524 Issued in KY
Practice address
120 N Eagle Creek Dr
Suite 360
Lexington, KY 40509-1827
Phone
(859) 258-5270
Fax
(859) 258-5202
NPI assigned
Jul 11, 2006
Last updated
Nov 2, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 26524 KY Primary
Pediatric Dermatology Physician 207NP0225X 26524 KY
Procedural Dermatology Physician 207NS0135X 26524 KY

Addresses

Primary practice location

120 N Eagle Creek Dr
Suite 360
Lexington, KY 40509-1827

Mailing address

120 N Eagle Creek Dr
Suite 360
Lexington, KY 40509-1827
Phone (859) 258-5270

Other identifiers 6

IdentifierTypeStateIssuer
CB5773OtherKYRAILROAD MEDICARE GROUP
37903705OtherKYMEDICAID LAB GROUP
64265242MedicaidKY
ASC1019OtherKYASC MEDICARE GROUP
36000818OtherKYASC MEDICAID LAB GROUP
4000501OtherKYMEDICARE LAB GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040301000298 KY Practitioner - Dermatology 5698662161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Louisville School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Lexington Clinic PSCGroup PAC ID 3476457532, 329 clinicians

Practice addresses (Care Compare)

120 N Eagle Creek Dr
Suite 360
Lexington, KY 40509-1827
Phone (859) 258-5270

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1287
Removal or shaving of skin growth56
Skin biopsy69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26524KYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Lexington Clinic PSC CurrentSince Apr 1, 1990 Accepting new patients
New Lexington Clinic, PSC CurrentSince Apr 1, 1990 Accepting new patients

Locations

120 N Eagle Creek Dr
Ste 360
Lexington, KY 40509
Phone (859) 258-5270

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

Interoperability endpoints

  • Direct secure messaging: gerald.elliott.1@13059.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1225063175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N EAGLE CREEK DR",
            "address_2": "SUITE 360",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405091827",
            "telephone_number": "859-258-5270",
            "fax_number": "859-258-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N EAGLE CREEK DR",
            "address_2": "SUITE 360",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405091827",
            "telephone_number": "859-258-5270",
            "fax_number": "859-258-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "GERALD",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KY",
            "license": "26524",
            "primary": true
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "KY",
            "license": "26524",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "KY",
            "license": "26524",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CB5773",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID LAB GROUP",
            "identifier": "37903705",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64265242",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC MEDICARE GROUP",
            "identifier": "ASC1019",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC MEDICAID LAB GROUP",
            "identifier": "36000818",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LAB GROUP",
            "identifier": "4000501",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.