Individual provider Active NPI

Subir Ghosh, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Jackson, KY
National Provider Identifier
1487657268
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
38152 Issued in KY
Practice address
832 Hwy 15 North
Jackson, KY 41339-8601
Phone
(606) 666-5142
Fax
(606) 666-4172
NPI assigned
May 24, 2005
Last updated
Oct 19, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 38152 KY Primary

Addresses

Primary practice location

832 Hwy 15 North
Jackson, KY 41339-8601

Mailing address

PO Box 907
Jackson, KY 41339-0907
Phone (606) 666-5142

Other identifiers 1

IdentifierTypeStateIssuer
64073885MedicaidKY

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
I20131226000923 KY Order and Referring Only - Geriatric MedicinePractitioner - Geriatric Medicine 4789675893

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PT Pros, IncGroup PAC ID 0143139337, shared by 14 NPIs, 263 clinicians

Practice addresses (Care Compare)

201 S Main St
Leitchfield, KY 42754-1425
Phone (270) 230-1729

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38152KYMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Green Valley Rural Clinics, LLC Geriatric Medicine Past Accepting new patients

Organizations & group practices 1

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.

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255910400000",
    "number": "1487657268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 907",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390907",
            "telephone_number": "606-666-5142",
            "fax_number": "606-666-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 HWY 15 NORTH",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413398601",
            "telephone_number": "606-666-5142",
            "fax_number": "606-666-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHOSH",
        "first_name": "SUBIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2009-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "KY",
            "license": "38152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64073885",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, KY

Sources for this page

Verify at the official NPI Registry.