NPIMap

Organization Active NPI

Pediatric Associates

Doing business as Pediatric Associates of Hazard

  • Rural Health Clinic/Center
  • Hazard, KY
National Provider Identifier
1487600615
Registry record updated Mar 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900138 Issued in KY
Legal business name
PEDIATRIC ASSOCIATES
Doing business as
Pediatric Associates of Hazard
Practice address
1710 N Main St
Pediatric Associates
Hazard, KY 41701-1278
Phone
(606) 487-8300
Fax
(606) 436-9953
NPI assigned
May 26, 2006
Last updated
Mar 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2019

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

Authorized official

Name
Djien Hwat So
Title
Administrator
Phone
(606) 487-8300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X 900138 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 3006127 KY

Addresses

Primary practice location

1710 N Main St
Pediatric Associates
Hazard, KY 41701-1278

Mailing address

PO Box 2748
Pediatric Associates
Pikeville, KY 41502-2748
Phone (606) 432-3221

Other identifiers 1

IdentifierTypeStateIssuer
35001627MedicaidKY

Other names 1

  • Pediatric Associates of Hazard Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050211000269 KY Part B Supplier - Clinic/Group Practice 9436147048 Receives reassigned benefits from 14 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hazard, KY; Stanton, KY; Pikeville, KY

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0997986Pediatric Associates1710 North Main Street, Hazard, KY 41701Certificate of waiverApr 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Medical Investment Trust2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

321C E College Ave
Stanton, KY 40380
Phone (606) 663-9797

Practitioners & affiliated clinicians

Practitioners 6

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": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1487600615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2748",
            "address_2": "PEDIATRIC ASSOCIATES",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415022748",
            "telephone_number": "606-432-3221",
            "fax_number": "606-437-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 N MAIN ST",
            "address_2": "PEDIATRIC ASSOCIATES",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417011278",
            "telephone_number": "606-487-8300",
            "fax_number": "606-436-9953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "SO",
        "authorized_official_first_name": "DJIEN",
        "authorized_official_middle_name": "HWAT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "606-487-8300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900138",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3006127",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001627",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Associates of Hazard",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Associates of Hazard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazard, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.