Pavan Bejgum, M.D
Individual provider Active NPI Internal Medicine Physician · Mayfield, KY
NPI 1437469343 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1437469343
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036.126543 (IL)
- Practice address
- 110 South 9TH Street
Mayfield, KY 42066-2208 - Phone
- (270) 247-7795
- Fax
- (800) 574-6540
- NPI assigned
- Oct 13, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52262 | KY | MD | Emergency Medicine Physician |
| 036.126543 | IL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Pain Management | Past | Accepting new patients |
Interoperability endpoints
- pbejgum@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 52262 | KY | |
| Internal Medicine Physician | 207R00000X | 036.126543 | IL | Yes |
Addresses
Primary practice location
110 South 9TH Street
Mayfield, KY 42066-2208
Mailing address
1029 Medical Center Cir Ste 202
Mayfield, KY 42066-1189
Phone (270) 247-7795
Other practice location 1
28 Chick St
Metropolis, IL 62960-2467
Phone (618) 638-1343
Other practice location 2
28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176 ext. 2382
Other practice location 3
1204 W 10th St
Metropolis, IL 62960-2433
Phone (618) 524-3572
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K348400 | Other | KY | MEDICARE |
| 7100167630 | Medicaid | KY |
Other providers in Mayfield, KY
- Jimmelyn Battoe
- Lori Leigh Batts
- Annette Darlene Beasley
- John Johnson Beasley
- Beck Mayfield Opco LLC
- Brittany Belt
- Christy Lee Benifield
- Puneet Bhatia
- Peggy Richardson Block
- Whitney Braden
All providers in Mayfield, 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 Jan 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.