NPIMap

Organization Active NPI

Pediatric Partners of Northern Kentucky

  • Pediatrics Physician
  • Ft Wright, KY
National Provider Identifier
1336209865
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC PARTNERS OF NORTHERN KENTUCKY
Practice address
1945 Highland Pike
Suite 1
Ft Wright, KY 41017-8127
Phone
(859) 331-4005
NPI assigned
Dec 12, 2006
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Rebecca Sprague
Title
Office Manager
Phone
(859) 331-4005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1945 Highland Pike
Suite 1
Ft Wright, KY 41017-8127

Mailing address

1945 Highland Pike
Suite 1
Ft Wright, KY 41017-8127
Phone (859) 331-4005

Other identifiers 1

IdentifierTypeStateIssuer
65943961MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners of Northern Kentucky2 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

1945 Highland Pike
Ste 1
Ft Wright, KY 41017
Phone (859) 331-4005

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 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1336209865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 HIGHLAND PIKE",
            "address_2": "SUITE 1",
            "city": "FT WRIGHT",
            "state": "KY",
            "postal_code": "410178127",
            "telephone_number": "859-331-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 HIGHLAND PIKE",
            "address_2": "SUITE 1",
            "city": "FT WRIGHT",
            "state": "KY",
            "postal_code": "410178127",
            "telephone_number": "859-331-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS OF NORTHERN KENTUCKY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "SPRAGUE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "859-331-4005"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943961",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Wright, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.