NPIMap

Organization Active NPI

Kentucky Mso LLC

  • Surgery Physician
  • Georgetown, KY
National Provider Identifier
1508101460
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
KENTUCKY MSO LLC
Practice address
1138 Lexington Rd
Suite 230
Georgetown, KY 40324-9672
Phone
(502) 570-3727
Fax
(502) 570-3753
NPI assigned
Dec 4, 2012
Last updated
Sep 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Authorized official

Name
Timothy D Vaughn
Title
Vice President
Phone
(615) 372-8500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1138 Lexington Rd
Suite 230
Georgetown, KY 40324-9672

Mailing address

1138 Lexington Rd
Suite 230
Georgetown, KY 40324-9672
Phone (502) 570-3727

Other names 1

  • Georgetown Bariatrics & Advanced Surgical Services Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110901000380 KY Part B Supplier - Clinic/Group Practice 0749450633 Receives reassigned benefits from 104 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Versailles, KY; Paris, KY; Mount Sterling, KY; West Liberty, KY; Winchester, KY; Georgetown, KY; Lawrencburg, KY; Lawrenceburg, KY…

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Bluegrass Family Care Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1354579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1508101460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 LEXINGTON RD",
            "address_2": "SUITE 230",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249672",
            "telephone_number": "502-570-3727",
            "fax_number": "502-570-3753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 LEXINGTON RD",
            "address_2": "SUITE 230",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249672",
            "telephone_number": "502-570-3727",
            "fax_number": "502-570-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY MSO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-04",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgetown Bariatrics & Advanced Surgical Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.