Bernard Damon Greenwell, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

13474 Issued in KY

Practice address

222 West Dixie Avenue
Elizabethtown, KY 42701

Phone

(270) 769-1219

Fax

(270) 769-5123

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316020951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 WALNUT HILL ROAD",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-765-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WEST DIXIE AVENUE",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-769-1219",
            "fax_number": "270-769-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWELL",
        "first_name": "BERNARD",
        "middle_name": "DAMON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "13474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1065979",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64134745",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grayson County Hospital Foundation Inc.
• Logan Anthony Greco, PA-C
• Merciful Grace Green
• Steven Alan Green
• Jennymarie Greenough, L.AC
• Beth Ann Greenwell, PT, MPT, CLT-LANA
• Erica C Greenwell, PA
• George Leo Greenwell Jr., OTR
• Kristen McCann Greenwell
• Gregory D. Smith

• Family Medicine Physician in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.