Elite Emergency Services of Kentucky, PLLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ELITE EMERGENCY SERVICES OF KENTUCKY, PLLC

Practice address

100 Medical Center Dr
Princeton, KY 42445-2430

Phone

(270) 365-0438

NPI assigned

Mar 19, 2012

Organization subpart

No

Name

Samuel C. Clemmons, M.D.NPI 1194893057

Title

President

Phone

(615) 928-6275

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

• Samuel Clay Clemmons, M.D.

  • Family Medicine Physician
  • Franklin, TN
  • NPI 1194893057

  Family Medicine

  NPD Authorized official
• Daniel G Bercu, DO

  • Emergency Medicine Physician
  • Barbourville, KY
  • NPI 1710926456

  Emergency Medicine

  NPD (past)
• Jeffrey L Frederich, M.D.

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1508882010

  Emergency Medicine

  NPD (past)
• Mohamed Alfaris, MD

  • Internal Medicine Physician
  • Tucson, AZ
  • NPI 1417148891

  Emergency Medicine

  NPD (past)
• Stephanie Demetric Anderson, MD

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1891084935

  Family Medicine

  NPD (past)
• Andrew M Freeman, D.O.

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1033167697

  Family Medicine

  NPD (past)
• Randel Gibson, DO

  • Family Medicine Physician
  • Pontotoc, MS
  • NPI 1750336335

  Family Medicine

  NPD (past)
• Syed Ahmed Naseeruddin, MD

  • Sports Medicine (Family Medicine) Physician
  • Clarksville, TN
  • NPI 1760599575

  Emergency Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 16, 2018.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1285909671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4458",
            "address_2": "DEPT 176",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104458",
            "telephone_number": "866-434-8164",
            "fax_number": "615-760-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER DR",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424452430",
            "telephone_number": "270-365-0438"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 Jett Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "KY",
            "postal_code": "413399622",
            "country_code": "US",
            "telephone_number": "606-666-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "320 W 18th St",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422401965",
            "country_code": "US",
            "telephone_number": "270-887-0338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELITE EMERGENCY SERVICES OF KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-928-6275",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100200270",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Dunaway, DNP, APRN, FNP-C
• Megan Duvall, MS, CCC-SLP
• E. W. James and Sons, Inc
• Easycare Inc
• Ed Settle, M.D.
• Emergency Staffing Solutions
• Eyecare Center of Princeton PLLC
• Chelsey Farless, APRN
• Fast Pace Kentucky, PLLC
• Shanna Leslie Faughn, RN

• All providers in Princeton, KY
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; 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.