Northside Pediatrics PSC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

19876 Issued in KY

Legal business name

NORTHSIDE PEDIATRICS PSC

Practice address

290 Old Jackson Hwy 31E Loop
Glasgow, KY 42141-9089

Phone

(270) 678-5740

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Sandra Dotson Moss, M.D.

Title

President

Phone

(270) 678-5740

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Morris D. Moss, M.D.

  • Emergency Medicine Physician
  • Glasgow, KY
  • NPI 1891738829

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295894137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 OLD JACKSON HWY 31E LOOP",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421419089",
            "telephone_number": "270-678-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 OLD JACKSON HWY 31E LOOP",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421419089",
            "telephone_number": "270-678-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PEDIATRICS PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "DOTSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-678-5740",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "19876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000057724",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64198765",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• New Glasgow Health & Rehabilitation Center, LLC
• Eddy Joe Newberry II, D.M.D.
• Gina Newberry
• NHC Healthcare-Glasgow LLC
• Ashley Ann Norris, DO
• Janet M O'Brien, RN., PSC
• Matthew Alan O'Connor, CRNA
• Chasity Brooke Oakes, MS, CCC/SLP
• Oaks Behavioral Health PLLC
• Candice Oberramer

• All providers in Glasgow, KY
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.