NPIMap

Organization Active NPI

Clarksville Limb & Brace & Rehab., Inc.

Doing business as Bowling Green Orthotics & Prosthetics

  • Prosthetic/Orthotic Supplier
  • Bowling Green, KY
National Provider Identifier
1275538860
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
CLARKSVILLE LIMB & BRACE & REHAB., INC.
Doing business as
Bowling Green Orthotics & Prosthetics
Practice address
1711 Ashley Cir Ste 8
Bowling Green, KY 42104-5801
Phone
(270) 780-0073
Fax
(270) 782-9962
NPI assigned
Jun 20, 2005
Last updated
Mar 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Authorized official

Name
Sumesh Saxena
Title
Owner of Bionic
Phone
(219) 791-9200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetics Case Management 1744P3200X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

1711 Ashley Cir Ste 8
Bowling Green, KY 42104-5801

Mailing address

980 Professional Park Dr Ste B
Clarksville, TN 37040-5251
Phone (931) 648-2155

Other identifiers 2

IdentifierTypeStateIssuer
000000190035OtherANTHEM
90262569MedicaidKY

Other names 1

  • Bowling Green Orthotics & Prosthetics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930075509 KY DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 7214053958 Practice locations: Bowling Green, KY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Bowling Green Orthotics & Prostheti1711 Ashley Cir, Bowling Green, KY 42104-5801(270) 780-0073 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Clarksville Limb Brace4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1169 Eastern Pkwy
Ste 4423
Louisville, KY 40217
Phone (502) 585-4228

980 Professional Park Dr
Ste B
Clarksville, TN 37040
Phone (931) 648-2155

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1275538860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 PROFESSIONAL PARK DR STE B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405251",
            "telephone_number": "931-648-2155",
            "fax_number": "931-647-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 ASHLEY CIR STE 8",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421045801",
            "telephone_number": "270-780-0073",
            "fax_number": "270-782-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE LIMB & BRACE & REHAB., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "SAXENA",
        "authorized_official_first_name": "SUMESH",
        "authorized_official_title_or_position": "OWNER OF BIONIC",
        "authorized_official_telephone_number": "219-791-9200"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000190035",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90262569",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bowling Green Orthotics & Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bowling Green Orthotics & Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.