NPIMap

Individual provider Active NPI

Maryann Hall, PAC

  • Physician Assistant
  • Lackey, KY
National Provider Identifier
1245238518
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA781 Issued in KY
Practice address
77 Millard Allen Dr
Lackey, KY 41643
Phone
(606) 358-2381
Fax
(606) 358-2404
NPI assigned
Jul 12, 2005
Last updated
Jul 16, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA781 KY Primary

Addresses

Primary practice location

77 Millard Allen Dr
Lackey, KY 41643

Mailing address

PO Box 190
Lackey, KY 41643-0190
Phone (606) 358-2381

Other identifiers 3

IdentifierTypeStateIssuer
95004073MedicaidKY
000001207618OtherCHA
000000313658OtherBCBS

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
I20101025000956 KY Practitioner - Physician Assistant 6901795780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Kentucky College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

129 Stone Trace Dr
Mt Sterling, KY 40353-9386
Phone (859) 498-6006

225 Hospital Dr
Winchester, KY 40391-7604

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA781KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clark Regional Physician Practices LLC CurrentSince Jul 1, 2018 Accepting new patients
Clark Regional Physician Practices LLC CurrentSince Jul 1, 2018 Accepting new patients
Our Lady of the Way Hospital, Inc Past Accepting new patients
Saint Joseph Health System, Inc. Physician Assistant Past Accepting new patients
Saint Joseph Health System, Inc. Past Accepting new patients
Kentucky Hospital, LLC Past Accepting new patients
Ira B Potter PSC Physician Assistant Past Accepting new patients

Locations

129 Stone Trace Dr
Mt Sterling, KY 40353
Phone (859) 498-6006

225 Hospital Dr
Ste 200A
Winchester, KY 40391
Phone (859) 737-6480

Interoperability endpoints

  • Direct secure messaging: maryann.hall.1@19475.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1245238518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "LACKEY",
            "state": "KY",
            "postal_code": "416430190",
            "telephone_number": "606-358-2381",
            "fax_number": "606-358-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MILLARD ALLEN DR",
            "city": "LACKEY",
            "state": "KY",
            "postal_code": "41643",
            "telephone_number": "606-358-2381",
            "fax_number": "606-358-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "MARYANN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95004073",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "000001207618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000313658",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackey, KY

Sources for this page

Verify at the official NPI Registry.