Professional Park Diagnostics PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROFESSIONAL PARK DIAGNOSTICS PLLC

Practice address

3346 Professional Park
Owensboro, KY 42303-4551

Phone

(270) 685-1066

Fax

(270) 713-0227

NPI assigned

May 14, 2019

Organization subpart

No

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

Authorized official

Name

Patrick Brian Gipe, MD

Title

Partner

Phone

(270) 685-1066

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Bluegrass Internal Medicine PLLC

  • Internal Medicine Physician
  • Owensboro, KY
  • NPI 1619973682

  Member Of

  NPD member

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1235795352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-685-1066",
            "fax_number": "270-713-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-685-1066",
            "fax_number": "270-713-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PARK DIAGNOSTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "GIPE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "270-685-1066",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100633920",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John A Price, MD
• Micah Ashley Price, APRN
• Primary Care Solutions, LLC
• Primary Care Solutions, LLC
• John Russell Prine, PHARM.D., RPH
• Professional Park Diagnostics PLLC
• Progressive Rehab, Inc.
• Progressive Sports Therapy, LLC.
• Progressive Sports Therapy, LLC.
• Progressive Therapy and Wellness

• All providers in Owensboro, KY
• Clinical Medical Laboratory in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.