NPIMap

Organization Active NPI

Unbridled Healthcare System LLC

  • General Practice Physician
  • London, KY
National Provider Identifier
1295461663
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
UNBRIDLED HEALTHCARE SYSTEM LLC
Practice address
220 N Main St
London, KY 40741-1367
Phone
(606) 770-3014
NPI assigned
Jul 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Authorized official

Name
Terri Tye
Title
Billing and Credentialing
Phone
(606) 215-3832

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

220 N Main St
London, KY 40741-1367

Mailing address

PO Box 2448
London, KY 40743-2448
Phone (606) 770-3014

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221003001081 KY Part B Supplier - Clinic/Group Practice 3274919097 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: London, KY

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Unbridled Healthcare System LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

220 N Main St
London, KY 40741
Phone (606) 770-3014

222 N Main St
London, KY 40741
Phone (606) 389-5250

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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": "1658966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1295461663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2448",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407432448",
            "telephone_number": "606-770-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N MAIN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411367",
            "telephone_number": "606-770-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNBRIDLED HEALTHCARE SYSTEM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-28",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "TYE",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "BILLING AND CREDENTIALING",
        "authorized_official_telephone_number": "606-215-3832"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.