Individual provider Active NPI

Carmela Fletcher-Green, PA-C

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1518948769
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA304 Issued in KY
Practice address
1306 Versailles Rd Ste 120
Lexington, KY 40504-1795
Phone
(859) 259-2635
NPI assigned
Nov 7, 2005
Last updated
Jun 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA304 KY Primary
Medical Physician Assistant 363AM0700X PA304 KY

Addresses

Primary practice location

1306 Versailles Rd Ste 120
Lexington, KY 40504-1795

Mailing address

1306 Versailles Rd Ste 120
Lexington, KY 40504-1795
Phone (859) 259-2635

Other identifiers 3

IdentifierTypeStateIssuer
11478958OtherKYCAQH
95002937MedicaidKY
970021336OtherKYRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100116000406 KY Practitioner - Physician Assistant 3173665916

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Claire Medical Center, Inc Physician Assistant Current Accepting new patients

Locations

222 Medical Cir
Morehead, KY 40351
Phone (606) 783-6455

316 W 2nd St
Morehead, KY 40351
Phone (606) 783-6400

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.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1518948769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 VERSAILLES RD STE 120",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405041795",
            "telephone_number": "859-259-2635",
            "fax_number": "592-547-8748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 VERSAILLES RD STE 120",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405041795",
            "telephone_number": "859-259-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER-GREEN",
        "first_name": "CARMELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA304",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA304",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11478958",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95002937",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970021336",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.