NPIMap

Organization Active NPI

Licking Valley Internal Medicine & Pediatrics PSC

  • Internal Medicine Physician
  • Cynthiana, KY
National Provider Identifier
1225136153
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC
Practice address
1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490
Phone
(859) 234-9611
Fax
(859) 235-0878
NPI assigned
Sep 21, 2006
Last updated
Apr 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Dr. William Frank McKemie Jr., MD
Title
President
Phone
(859) 234-9611

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490

Mailing address

1210 Ky Highway 36 E
Suite 2a
Cynthiana, KY 41031-7490
Phone (859) 234-9611

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000532 KY Part B Supplier - Clinic/Group Practice 3678463379 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Cynthiana, KY; Paris, KY

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1225136153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 KY HIGHWAY 36 E",
            "address_2": "SUITE 2A",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410317490",
            "telephone_number": "859-234-9611",
            "fax_number": "859-235-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 KY HIGHWAY 36 E",
            "address_2": "SUITE 2A",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410317490",
            "telephone_number": "859-234-9611",
            "fax_number": "859-235-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING VALLEY INTERNAL MEDICINE & PEDIATRICS PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "MCKEMIE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-234-9611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "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": []
}

Other providers in Cynthiana, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.