Brian W Vander Boegh, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

19738 Issued in KY

Practice address

1530 Lone Oak Rd
Emergency Department
Paducah, KY 42003-7901

Phone

(270) 444-2150

Fax

(270) 444-2985

NPI assigned

Sep 27, 2005

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Jackson Purchase ER Physicians, PSC

  • Emergency Medicine Physician
  • Paducah, KY
  • NPI 1093701823
  NPD (past) Authorized official

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1356337182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636961",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636961",
            "telephone_number": "513-981-5130",
            "fax_number": "513-981-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 LONE OAK RD",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037901",
            "telephone_number": "270-444-2150",
            "fax_number": "270-444-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BOEGH",
        "first_name": "BRIAN",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "19738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64197387",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Uthoff, PTA
• Kimberly Seitz Valerius, PTA
• Dorris H Van Dyke, LPCC
• Jacquelyn E Van Waters, NP-C
• Kalthy Vance
• James D Vanhoose, MD
• Vascular Associates, PLLC
• Vascular Specialists,PLLC
• Elizabeth Vaughan
• Jennifer Vaughan

• Emergency Medicine Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.