Individual provider Active NPI

Carly Rose Ulrich, DO

  • Urology Physician
  • Charleston, WV
National Provider Identifier
1457811309
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4878 Issued in WV
Practice address
1220 Lee St E Ste 100
Charleston, WV 25301-1864
Phone
(304) 388-1965
NPI assigned
Mar 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 4878 WV Primary
Urology Physician 208800000X 06149 KY

Addresses

Primary practice location

1220 Lee St E Ste 100
Charleston, WV 25301-1864

Mailing address

3200 Maccorkle Ave SE FL 4
Charleston, WV 25304-1227
Phone (304) 388-5590

Other practice location 1

740 S Limestone
Lexington, KY 40536-0284
Phone (859) 257-3533

Other identifiers 1

IdentifierTypeStateIssuer
1457811309MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250508001618 KY Practitioner - Urology 8921337320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kentucky Medical Services Foundation, IncGroup PAC ID 5698689909, 949 clinicians

Practice addresses (Care Compare)

740 S Limestone St
Lexington, KY 40508-1683
Phone (859) 257-8562

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
06149KYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Medical Services Foundation, Inc CurrentSince May 1, 2025 Accepting new patients
University of Kentucky CurrentSince May 1, 2025 Accepting new patients

Locations

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

2400 Greatstone Pt
Lexington, KY 40504
Phone (859) 257-9800

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1457811309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE FL 4",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5590",
            "fax_number": "304-388-8238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 LEE ST E STE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011864",
            "telephone_number": "304-388-1965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "740 S Limestone",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405360284",
            "country_code": "US",
            "telephone_number": "859-257-3533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ULRICH",
        "first_name": "CARLY",
        "middle_name": "ROSE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WV",
            "license": "4878",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "06149",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457811309",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.