Organization Active NPI

Central Cardiology Associates PLLC

  • Cardiovascular Disease Physician
  • Elizabethtown, KY
National Provider Identifier
1265496483
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CENTRAL CARDIOLOGY ASSOCIATES PLLC
Practice address
1324 Woodland Drive
Suite a
Elizabethtown, KY 42701
Phone
(270) 765-5921
Fax
(270) 769-0000
NPI assigned
Apr 14, 2006
Last updated
Sep 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Authorized official

Name
Mrs. Melissa Pruitt
Title
Administrator
Phone
(270) 765-5921

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

1324 Woodland Drive
Suite a
Elizabethtown, KY 42701

Mailing address

1324 Woodland Drive
Suite a
Elizabethtown, KY 42701
Phone (270) 765-5921

Other identifiers 1

IdentifierTypeStateIssuer
65912859MedicaidKY

National Provider Directory

National Provider Directory

Locations

Dept 8025
Carol Stream, IL 60122

111 Kingswood Dr
Ste A
Campbellsvlle, KY 42718
Phone (270) 789-3410

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1265496483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 WOODLAND DRIVE",
            "address_2": "SUITE A",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-765-5921",
            "fax_number": "270-769-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 WOODLAND DRIVE",
            "address_2": "SUITE A",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-765-5921",
            "fax_number": "270-769-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CARDIOLOGY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "270-765-5921",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65912859",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.