Individual provider Active NPI

Heather Graham

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1245668557
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3010256 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-2250
Fax
(859) 572-2326
NPI assigned
Oct 23, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X COA.15192NP OH
Nurse Practitioner 363L00000X 3010256 KY Primary

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 18667
Erlanger, KY 41018-0667
Phone (513) 312-2247

Other practice location 1

238 Barnes Rd
Williamstown, KY 41097-9482
Phone (859) 824-8240

Other practice location 2

85 N Grand Ave
Fort Thomas, KY 41075-1793
Phone (859) 572-3618

Other practice location 3

4900 Houston Rd
Florence, KY 41042-4824
Phone (859) 212-5441

Other practice location 4

1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone (859) 655-4353

Other identifiers 1

IdentifierTypeStateIssuer
7100347370MedicaidKY

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170630001664 KY Practitioner - Nurse Practitioner 7719114875 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Compass Emergency Physicians PSCGroup PAC ID 8224350939, 83 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-2250

Merit-based Incentive Payment System (MIPS)

Final score
93.13 of 100Reported as group
Quality
89.38
Improvement activities
40
Cost
79.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.15192NPOHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Emergency Physicians PSC Nurse Practitioner CurrentSince May 21, 2017 Accepting new patients

Locations

1500 James Simpson Jr Way
Covington, KY 41011
Phone (859) 655-4353

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

85 N Grand Ave
Fort Thomas, KY 41075
Phone (859) 572-3100

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Organizations & group practices 1

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": "1382486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1245668557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18667",
            "city": "ERLANGER",
            "state": "KY",
            "postal_code": "410180667",
            "telephone_number": "513-312-2247",
            "fax_number": "859-572-2326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-2250",
            "fax_number": "859-572-2326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "238 Barnes Rd",
            "address_purpose": "LOCATION",
            "city": "Williamstown",
            "state": "KY",
            "postal_code": "410979482",
            "country_code": "US",
            "telephone_number": "859-824-8240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 N Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Thomas",
            "state": "KY",
            "postal_code": "410751793",
            "country_code": "US",
            "telephone_number": "859-572-3618",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4900 Houston Rd",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "KY",
            "postal_code": "410424824",
            "country_code": "US",
            "telephone_number": "859-212-5441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 James Simpson Jr Way",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "KY",
            "postal_code": "410110801",
            "country_code": "US",
            "telephone_number": "859-655-4353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "HEATHER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-23",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA.15192NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3010256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100347370",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.