Individual provider Active NPI

Forrest A Hanke, MD

  • Family Medicine Physician
  • Madisonville, KY
National Provider Identifier
1295831279
Registry record updated Jan 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25587 Issued in KY
Practice address
200 Clinic Dr
Madisonville, KY 42431-1661
Phone
(270) 825-7200
NPI assigned
Sep 16, 2006
Last updated
Jan 8, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25587 KY Primary

Addresses

Primary practice location

200 Clinic Dr
Madisonville, KY 42431-1661

Mailing address

200 Clinic Dr
Madisonville, KY 42431-1661

Other identifiers 3

IdentifierTypeStateIssuer
25587OtherKYLICENSE
000000044290OtherBCBS PROVIDER NUMBER
64255870MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100112000349 KY Practitioner - Family Practice 8628119716 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25587KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohio Valley Neurology LLC Current Accepting new patients
Baptist Health Medical Group Inc Family Medicine CurrentSince Aug 1, 2016 Accepting new patients

Locations

2700 Stanley Gault Pkwy
Ste 129
Louisville, KY 40223
Phone (502) 253-4900

200 Clinic Dr
Madisonville, KY 42431
Phone (270) 821-8874

900 Hospital Dr
Madisonville, KY 42431
Phone (270) 326-3900

2603 Kentucky Ave
Ste 304
Paducah, KY 42003
Phone (270) 415-4800

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1295831279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-825-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANKE",
        "first_name": "FORREST",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "25587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "25587",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "000000044290",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64255870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madisonville, KY

Sources for this page

Verify at the official NPI Registry.