NPIMap

Organization Active NPI

Emergency Medicine Physicians of Estill County,PLLC

  • Emergency Medicine Physician
  • Irvine, KY
National Provider Identifier
1407235666
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EMERGENCY MEDICINE PHYSICIANS OF ESTILL COUNTY,PLLC
Practice address
60 Mercy CT
Irvine, KY 40336
Phone
(330) 493-4443
NPI assigned
May 21, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dominic Bagnoli
Title
Executive Chairman
Phone
(330) 493-4443

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20150715001677 KY Part B Supplier - Clinic/Group Practice 1850604141 Receives reassigned benefits from 53 practitioners
Practice locations: Irvine, KY

National Provider Directory

National Provider Directory

Locations

81 Ball Park Rd
Harlan, KY 40831
Phone (606) 573-8100

103 Keystone Dr
Ste 5
Richmond, KY 40475
Phone (859) 353-8884

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

NPPES NPI Registry

Primary practice location

60 Mercy CT
Irvine, KY 40336

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 493-4443

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 25, 2018.

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1407235666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443",
            "fax_number": "330-493-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MERCY CT",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "40336",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE PHYSICIANS OF ESTILL COUNTY,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "BAGNOLI",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "EXECUTIVE CHAIRMAN",
        "authorized_official_telephone_number": "330-493-4443"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.