Active NPI
Gregory P Weckenbrock, MD
- Family Medicine Physician
- Edgewood, KY
National Provider Identifier
1265459838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 23567
- Practice address
- 830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102 - Phone
- (859) 341-5757
- Fax
- (859) 331-4757
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 23567 | KY | Primary |
Addresses
Primary practice location
830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Mailing address
830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Phone (859) 341-5757
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0638582 | Medicaid | OH | |
| 64235674 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23567 | KY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients | |
| Family Care of Northern Kentucky, PLLC | Family Medicine | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Family Care of Northern Kentucky, PLLC | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Edgewood, KY
- NPI 1952334054
-
- Family Nurse Practitioner
- Edgewood, KY
- NPI 1295949667
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190332800000",
"number": "1265459838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 THOMAS MORE PKWY",
"address_2": "STE 203",
"city": "EDGEWOOD",
"state": "KY",
"postal_code": "410175102",
"telephone_number": "859-341-5757",
"fax_number": "859-331-4757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 THOMAS MORE PKWY",
"address_2": "STE 203",
"city": "EDGEWOOD",
"state": "KY",
"postal_code": "410175102",
"telephone_number": "859-341-5757",
"fax_number": "859-331-4757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WECKENBROCK",
"first_name": "GREGORY",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "23567",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0638582",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64235674",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edgewood, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.