NPIMap

Organization Active NPI

West Kentucky Dermatology, PSC

  • Dermatology Physician
  • Madisonville, KY
National Provider Identifier
1275580888
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WEST KENTUCKY DERMATOLOGY, PSC
Practice address
95 YMCA Dr
Madisonville, KY 42431-9035
Phone
(270) 821-0066
Fax
(270) 821-6580
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
William F. Smith III, M.DNPI 1538108873
Title
President
Phone
(270) 821-0066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

95 YMCA Dr
Madisonville, KY 42431-9035

Mailing address

95 YMCA Dr Ste 3
Madisonville, KY 42431-9035
Phone (270) 821-0066

Other identifiers 3

IdentifierTypeStateIssuer
65943334MedicaidKY
78904885MedicaidKY
95901203MedicaidKY

Other names 1

  • West Kentucky Dermatology, PSC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050209000551 KY Part B Supplier - Clinic/Group Practice 5193776979 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Madisonville, KY; Mount Washington, KY; Shelbyville, KY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
18D0994891West Kentucky Dermatology95 YMCA Drive, Madisonville, KY 42431Provider-performed microscopyMar 5, 2027

National Provider Directory

National Provider Directory

Locations

211 High Point Ct
Ste 600
Mount Washington, KY 40047
Phone (502) 386-8876

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1275580888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 YMCA DR STE 3",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424319035",
            "telephone_number": "270-821-0066",
            "fax_number": "270-821-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 YMCA DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424319035",
            "telephone_number": "270-821-0066",
            "fax_number": "270-821-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST KENTUCKY DERMATOLOGY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-821-0066",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943334",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78904885",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95901203",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Kentucky Dermatology, PSC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Kentucky Dermatology, PSC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madisonville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.