Bluegrass Surgical Association, PSC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25747 Issued in KY

Legal business name

BLUEGRASS SURGICAL ASSOCIATION, PSC

Practice address

996 Wilkinson Trce
Suite A5
Bowling Green, KY 42103-3407

Phone

(270) 782-5219

Fax

(270) 793-9385

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

John L Korba, MD

Title

President

Phone

(270) 782-5219

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Todd Bergin, MD

  • Surgery Physician
  • Salem, KY
  • NPI 1396708566

  Specialist

  NPD (past)
• Mark Allen Casebolt, MD

  • Surgery Physician
  • Ocala, FL
  • NPI 1881633402
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1497814768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "996 WILKINSON TRCE",
            "address_2": "SUITE A5",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421033407",
            "telephone_number": "270-782-5219",
            "fax_number": "270-793-9385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "996 WILKINSON TRCE",
            "address_2": "SUITE A5",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421033407",
            "telephone_number": "270-782-5219",
            "fax_number": "270-793-9385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS SURGICAL ASSOCIATION, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "KORBA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-782-5219",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "25747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65924375",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bluegrass Counseling & Wellness
• Bluegrass Med Care
• Bluegrass Medical Care LLC
• Bluegrass Oral Health Center PLLC
• Bluegrass Outpatient Center of Bowling Green, L.L.C.
• Daniel Agyei Boamah, LCSW
• Irene Boamah, C.S.W
• Tyanna Boards
• Body Works Chiropractic PSC
• Ashley M Bogenreif, MT

• All providers in Bowling Green, KY
• Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.