Individual provider Active NPI

Thomas Doncaster, D.O.

  • Family Medicine Physician
  • Williamsburg, KY
National Provider Identifier
1366530586
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02454 Issued in KY
Practice address
475 N Highway 25 W
Suite 100
Williamsburg, KY 40769-1576
Phone
(606) 549-2933
Fax
(606) 549-3036
NPI assigned
Oct 11, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 DO0000001103 TN
Family Medicine Physician 207Q00000X 02454 KY Primary

Addresses

Primary practice location

475 N Highway 25 W
Suite 100
Williamsburg, KY 40769-1576

Mailing address

PO Box 247
Jellico, TN 37762-0247
Phone (423) 784-0269

Other identifiers 2

IdentifierTypeStateIssuer
3304309MedicaidTN
64024540MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20130619000031 NM Practitioner - Family Practice 8729104096 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
02454KYMDFamily Medicine Physician
DO0000001103TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Family Medicine CurrentSince Nov 23, 2019 Accepting new patients
Jellico Community Hospital, Inc Past Accepting new patients
Wynn Habersham Community Clinic Inc Past Accepting new patients

Locations

2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000

402 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-1660

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366530586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377620247",
            "telephone_number": "423-784-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 N HIGHWAY 25 W",
            "address_2": "SUITE 100",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691576",
            "telephone_number": "606-549-2933",
            "fax_number": "606-549-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONCASTER",
        "first_name": "THOMAS",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "DO0000001103",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3304309",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64024540",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

Verify at the official NPI Registry.