NPIMap

Individual provider Active NPI

Robert L. Bertram, D.O.

  • Internal Medicine Physician
  • Russell Springs, KY
National Provider Identifier
1417008756
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02506 Issued in KY
Practice address
92 Joe T Petty Dr
Russell Springs, KY 42642-8543
Phone
(270) 866-8881
Fax
(270) 866-8849
NPI assigned
Jan 15, 2007
Last updated
Jun 5, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 02506 KY Primary

Addresses

Primary practice location

92 Joe T Petty Dr
Russell Springs, KY 42642-8543

Mailing address

92 Joe T Petty Dr
Suite 400
Russell Springs, KY 42642-8544
Phone (270) 866-8881

Other identifiers 4

IdentifierTypeStateIssuer
000000064586OtherKYANTHEM
608475500OtherKYBLACK LUNG
110185245OtherKYRAILROAD MEDICARE
64025067MedicaidKY

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)
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
02506KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nexus Lab Inc PastSince Sep 2, 2002 Accepting new patients
Nexus Lab 2.0 LLC PastSince Oct 7, 2011 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: robert.bertram.1@14940.direct.athenahealth.com
  • Direct secure messaging: robert.bertram@195556196810756.direct.elationemr.com
  • Direct secure messaging: robert.bertram@56434976161796.direct.elationemr.com

Organizations & group practices 11

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": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1417008756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 JOE T PETTY DR",
            "address_2": "SUITE 400",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426428544",
            "telephone_number": "270-866-8881",
            "fax_number": "270-866-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 JOE T PETTY DR",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426428543",
            "telephone_number": "270-866-8881",
            "fax_number": "270-866-8849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "ROBERT",
        "middle_name": "L.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "02506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000064586",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "608475500",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110185245",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64025067",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russell Springs, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.