NPIMap

Organization Active NPI

Bluegrass Pediatrics and Internal Medicine, PLLC

  • Pediatrics Physician
  • Georgetown, KY
National Provider Identifier
1427229707
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
41057 Issued in KY
Legal business name
BLUEGRASS PEDIATRICS AND INTERNAL MEDICINE, PLLC
Practice address
196 Bevins LN
Suite F
Georgetown, KY 40324-8534
Phone
(502) 863-2818
Fax
(502) 863-2764
NPI assigned
Mar 14, 2008
Last updated
Dec 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Authorized official

Name
Dr. Andrew P. Balbaugh, MDNPI 1265640411
Title
Partner
Phone
(502) 863-2818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 41057 KY
Pediatrics Physician 208000000X 41057 KY Primary

Addresses

Primary practice location

196 Bevins LN
Suite F
Georgetown, KY 40324-8534

Mailing address

196 Bevins LN
Suite F
Georgetown, KY 40324-8534
Phone (502) 863-2818

Other identifiers 2

IdentifierTypeStateIssuer
7100047760MedicaidKY
7100059860MedicaidKY

National Provider Directory

National Provider Directory

Locations

196 Bevins Ln
Ste F
Georgetown, KY 40324
Phone (502) 863-2818

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1427229707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 BEVINS LN",
            "address_2": "SUITE F",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403248534",
            "telephone_number": "502-863-2818",
            "fax_number": "502-863-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 BEVINS LN",
            "address_2": "SUITE F",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403248534",
            "telephone_number": "502-863-2818",
            "fax_number": "502-863-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS PEDIATRICS AND INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "BALBAUGH",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "502-863-2818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "41057",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "41057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100047760",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100059860",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.