Individual provider Active NPI

Robert L Wyenandt Jr., MD

  • Hospitalist Physician
  • Edgewood, KY
National Provider Identifier
1326035635
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
30652 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-8074
Fax
(859) 301-4945
NPI assigned
Oct 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30652 KY
Hospitalist Physician 208M00000X 30652 KY Primary

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-8074

Other identifiers 4

IdentifierTypeStateIssuer
64306525MedicaidKY
200407630MedicaidIN
2401243MedicaidOH
P01555163OtherKYRR MEDICARE

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
I20040520001201 KY Practitioner - Family Practice 4284625922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 212-4468

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc Family Medicine CurrentSince Nov 1, 2015 Accepting new patients
Summit Medical Group, Inc. CurrentSince Nov 1, 2015 Accepting new patients
St Elizabeth Medical Center, Inc Past Accepting new patients

Locations

747 Buttermilk Pike
Crescent Springs, KY 41017
Phone (859) 292-4960

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Organizations & group practices 3

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1326035635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-8074",
            "fax_number": "859-301-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-8074",
            "fax_number": "859-301-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYENANDT",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "30652",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "KY",
            "license": "30652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64306525",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200407630",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2401243",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01555163",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.