NPIMap

Organization Active NPI

Iris Medical Group Kentucky LLC

  • Primary Care Clinic/Center
  • Bowling Green, KY
National Provider Identifier
1336908110
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
IRIS MEDICAL GROUP KENTUCKY LLC
Practice address
1131 Magnolia St
Bowling Green, KY 42103-2411
Phone
(615) 873-4490
NPI assigned
Mar 15, 2024
Last updated
Mar 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Joel Parker, MDNPI 1326211012
Title
President
Phone
(615) 873-4490

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

1131 Magnolia St
Bowling Green, KY 42103-2411

Mailing address

330 Franklin Rd Ste 135-A270
Brentwood, TN 37027-3280
Phone (615) 873-4490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241014004226 KY Part B Supplier - Clinic/Group Practice 3971035064 Receives reassigned benefits from 3 practitioners
Practice locations: Bowling Green, KY

National Provider Directory

National Provider Directory

Locations

1131 Magnolia St
Bowling Green, KY 42103
Phone (615) 873-4490

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1710460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1336908110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 FRANKLIN RD STE 135-A270",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273280",
            "telephone_number": "615-873-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 MAGNOLIA ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032411",
            "telephone_number": "615-873-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRIS MEDICAL GROUP KENTUCKY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-873-4490",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.