Springfield Medical Assoc PSC
Organization Active NPI Internal Medicine Physician · Springfield, KY
NPI 1386620102 · NPPES record last updated Dec 21, 2023
Key facts
- NPI
- 1386620102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- SPRINGFIELD MEDICAL ASSOC PSC
- Practice address
- 219 W Main St
Springfield, KY 40069-1228 - Phone
- (859) 336-7795
- Fax
- (859) 336-7020
- NPI assigned
- Dec 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Christopher Brown
- Title
- Office Manager
- Phone
- (859) 336-7795
Practitioners 6
-
Jacquelyn R Blandford, APRN
-
Elizabeth Anne Shelton, APRN
-
Kenny Lane Bowman, D.O.
-
Maung Kyaw Win, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0884003 | Springfield Medical Associates Inc | Certificate of waiver | Mar 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050919000487 | KY | Part B Supplier - Clinic/Group Practice | 8820021918 |
Receives reassigned benefits from 3 practitioners Practice locations: Springfield, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
219 W Main St
Springfield, KY 40069-1228
Mailing address
219 W Main St
Springfield, KY 40069-1228
Phone (859) 336-7795
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65931826 | Medicaid | KY |
Other providers in Springfield, KY
- Brianna Paige Spalding
- Spring View Hospital LLC
- Spring View Hospital, LLC
- Springfield Health Center LLC
- Springfield Health Facilities LP
- Springfield Physical Therapy, LLC
- Dawn C Taylor
- Gail Ballard Taylor
- Terra S Taylor
- Joanna Filiatreau Tennill
All providers in Springfield, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.