NPIMap

Organization Active NPI

Owensboro Health Medical Group, Inc

  • Nurse Practitioner
  • Owensboro, KY
National Provider Identifier
1265856181
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
OWENSBORO HEALTH MEDICAL GROUP, INC
Practice address
1325 Triplett St # B
Owensboro, KY 42303-3163
Phone
(270) 688-4325
Fax
(270) 687-4322
NPI assigned
Feb 12, 2014
Organization subpart
Yes
Parent organization
OWENSBORO HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Authorized official

Name
Russell S Ranallo
Title
Secretary
Phone
(270) 417-4813

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X KY
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1325 Triplett St # B
Owensboro, KY 42303-3163

Mailing address

PO Box 23229
Owensboro, KY 42304-3229
Phone (270) 688-4325

Other names 1

  • Owensboro Health Wound Center-Owensboro Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621000818 KY Part B Supplier - Clinic/Group Practice 0648255034 Receives reassigned benefits from 677 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2054603Owensboro Health Wound Center1325 Triplett Street Suite B, Owensboro, KY 42303Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mohammed Kaleemuddin MD74 organizations share this tax ID, including this one
Part of
Owensboro Medical Health

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1325 Triplett St
Owensboro, KY 42303
Phone (270) 686-8500

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1265856181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-4325",
            "fax_number": "270-687-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 TRIPLETT ST # B",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423033163",
            "telephone_number": "270-688-4325",
            "fax_number": "270-687-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENSBORO HEALTH MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OWENSBORO HEALTH, INC",
        "enumeration_date": "2014-02-12",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "RANALLO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "270-417-4813"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owensboro Health Wound Center-Owensboro",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Owensboro Health Wound Center-Owensboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owensboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.