Individual provider Active NPI

Roger Lea Humphrey, M.D.

  • Surgery Physician
  • Owensboro, KY
National Provider Identifier
1245239292
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
19761 Issued in KY
Practice address
2801 New Hartford Rd
Owensboro, KY 42303-1320
Phone
(270) 683-3720
Fax
(270) 686-7331
NPI assigned
Jul 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01046282A IN
Vascular Surgery Physician 2086S0129X 01046282A IN
Vascular Surgery Physician 2086S0129X 19761 KY
Surgery Physician 208600000X 19761 KY Primary

Addresses

Primary practice location

2801 New Hartford Rd
Owensboro, KY 42303-1320

Mailing address

2801 New Hartford Rd
Owensboro, KY 42303-1320
Phone (270) 683-3720

Other identifiers 8

IdentifierTypeStateIssuer
200132180OtherINMOLINA
200132180MedicaidIN
611059472OtherKYDART
64197619MedicaidKY
6110594722109OtherINCARESOURCE
000000048413OtherKYANTHEM
611059472OtherUMWA
020038275OtherRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhumphrey5547@direct.owensborohealth.org Owensboro Health Medical Group, Inc

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
I20100723000443 KY Practitioner - General Surgery 4486725991 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19761KYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Owensboro Health Medical Group Inc Surgery Current Accepting new patients
Owensboro Health Medical Group, Inc Surgery CurrentSince May 1, 2013 Accepting new patients

Locations

421 7th St
Tell City, IN 47586
Phone (812) 547-7448

2211 Mayfair Dr
Ste 102
Owensboro, KY 42301
Phone (270) 688-1351

2801 New Hartford Rd
Owensboro, KY 42303
Phone (270) 683-3720

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1245239292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 NEW HARTFORD RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031320",
            "telephone_number": "270-683-3720",
            "fax_number": "270-686-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NEW HARTFORD RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031320",
            "telephone_number": "270-683-3720",
            "fax_number": "270-686-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "ROGER",
        "middle_name": "LEA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01046282A",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IN",
            "license": "01046282A",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "KY",
            "license": "19761",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "19761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "200132180",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200132180",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DART",
            "identifier": "611059472",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64197619",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "6110594722109",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000048413",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "611059472",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020038275",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhumphrey5547@direct.owensborohealth.org",
            "affiliation": "Y",
            "affiliationName": "Owensboro Health Medical Group, Inc",
            "address_1": "2801 New Hartford Rd",
            "city": "Owensboro",
            "state": "KY",
            "country_code": "US",
            "postal_code": "423031320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

Verify at the official NPI Registry.