Active NPI
Thomas Fred Coburn, M.D.
- Family Medicine Physician
- Wilmore, KY
National Provider Identifier
1386623601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 31991
- Practice address
- 200 Rice St
Wilmore, KY 40390-1359 - Phone
- (859) 858-9355
- Fax
- (859) 858-0416
- NPI assigned
- Jan 13, 2006
- Last updated
- Jul 11, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31991 | KY | Primary |
Addresses
Primary practice location
200 Rice St
Wilmore, KY 40390-1359
Mailing address
PO Box 936
London, KY 40743-0936
Phone (606) 330-7818
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64319916 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurosurgical Associates PSC | Current | Accepting new patients | |
| Jessamine Christian Healthcare, Inc. | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- thomascoburn@kysjhspe.allscriptsdirect.net
Organizations & group practices 2
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.
-
- Neurological Surgery Physician
- Lexington, KY
- NPI 1235110925
-
dba Jessamine Christian Healthcare
- Internal Medicine Physician
- Wilmore, KY
- NPI 1073643599
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562803200000",
"number": "1386623601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 936",
"city": "LONDON",
"state": "KY",
"postal_code": "407430936",
"telephone_number": "606-330-7818",
"fax_number": "606-330-7825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 RICE ST",
"city": "WILMORE",
"state": "KY",
"postal_code": "403901359",
"telephone_number": "859-858-9355",
"fax_number": "859-858-0416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "THOMAS",
"middle_name": "FRED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-13",
"last_updated": "2019-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "31991",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64319916",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmore, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.