NPIMap

Organization Active NPI

Radcliff Urgent Care Clinic LLC

  • Urgent Care Clinic/Center
  • Radcliff, KY
National Provider Identifier
1508595034
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
RADCLIFF URGENT CARE CLINIC LLC
Practice address
650 W Lincoln Trail Blvd
Radcliff, KY 40160-2681
Phone
(270) 352-4601
Fax
(270) 352-4600
NPI assigned
Jun 9, 2022
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
Donald Emerson Dick, PANPI 1679926448
Title
Primary Owner
Phone
(270) 352-4601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Internal Medicine Physician 207R00000X NU
Urgent Care Clinic/Center 261QU0200X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

650 W Lincoln Trail Blvd
Radcliff, KY 40160-2681

Mailing address

650 W Lincoln Trail Blvd
Radcliff, KY 40160-2681
Phone (270) 352-4601

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220705002885 KY Part B Supplier - Clinic/Group Practice 2264812510 Receives reassigned benefits from 6 practitioners
Practice locations: Radcliff, KY

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
18D2263262Radcliff Urgent Care Clinic, LLC650 West Lincoln Trail Blvd, Radcliff, KY 40160Certificate of waiverJun 24, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25653/brand/1/csg/1/fhir/r4

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": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1508595034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W LINCOLN TRAIL BLVD",
            "city": "RADCLIFF",
            "state": "KY",
            "postal_code": "401602681",
            "telephone_number": "270-352-4601",
            "fax_number": "270-352-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W LINCOLN TRAIL BLVD",
            "city": "RADCLIFF",
            "state": "KY",
            "postal_code": "401602681",
            "telephone_number": "270-352-4601",
            "fax_number": "270-352-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADCLIFF URGENT CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "EMERSON",
        "authorized_official_title_or_position": "PRIMARY OWNER",
        "authorized_official_telephone_number": "270-352-4601",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Radcliff, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.