Individual provider Active NPI

Raekwon Timmons, DO

  • Family Medicine Physician
  • Lexington, KY
National Provider Identifier
1386346716
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
06334 Issued in KY
Practice address
2040 Harrodsburg Rd Ste 100
Lexington, KY 40503-1712
Phone
(859) 899-7990
Fax
(859) 899-7991
NPI assigned
Mar 20, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 06334 KY Primary

Addresses

Primary practice location

2040 Harrodsburg Rd Ste 100
Lexington, KY 40503-1712

Mailing address

2040 Harrodsburg Rd Ste 100
Lexington, KY 40503-1712
Phone (859) 899-7990

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
I20260604001650 KY Practitioner - Family Practice 3173094760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1901 Campus PL
Louisville, KY 40299-2308

500 W Jefferson St
Suite 2310
Louisville, KY 40202-2881

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
06334KYMDGeneral Practice Dentistry

Organizations & group practices 1

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": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1386346716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 HARRODSBURG RD STE 100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031712",
            "telephone_number": "859-899-7990",
            "fax_number": "859-899-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 HARRODSBURG RD STE 100",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031712",
            "telephone_number": "859-899-7990",
            "fax_number": "859-899-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMMONS",
        "first_name": "RAEKWON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "06334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.