Courtney Tadic, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2787 Issued in KY

Practice address

1138 Lexington Rd Ste 290
Georgetown, KY 40324-9672

Phone

(502) 863-0721

Fax

(502) 863-6104

NPI assigned

Apr 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Proactive Therapy, IncGroup PAC ID 0143245415, 118 clinicians

Kentucky Mso LLCGroup PAC ID 0749450633, 53 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Georgetown Community Hospital Hospital, Georgetown, KY, CCN 180101

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: courtney.tadic.1@19475.direct.athenahealth.com
• Direct secure messaging: courtney.tadic.1@13059.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kentucky Mso LLC

  • Gastroenterology Physician
  • Georgetown, KY
  • NPI 1164867883
  Medicare reassignment Care Compare group
• Proactive Therapy, Inc

  • Occupational Therapist
  • Frankfort, KY
  • NPI 1932132149
  Care Compare group
• Kentucky Mso LLC

  • Surgery Physician
  • Georgetown, KY
  • NPI 1508101460

  Physician Assistant

  NPD
• Kentucky Mso LLC

  • Rural Health Clinic/Center
  • Lawrenceburg, KY
  • NPI 1922860758
  NPD
• Kentucky Mso LLC

  • Hematology & Oncology Physician
  • Georgetown, KY
  • NPI 1336483957

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Georgetown Community Hospital LLC

  • Rural Acute Care Hospital
  • Georgetown, KY
  • NPI 1326107319
  Care Compare affiliation

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1568041382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6200",
            "fax_number": "859-258-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 LEXINGTON RD STE 290",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249672",
            "telephone_number": "502-863-0721",
            "fax_number": "502-863-6104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Medical Heights Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Frankfort",
            "state": "KY",
            "postal_code": "406014137",
            "country_code": "US",
            "telephone_number": "502-226-7054",
            "fax_number": "502-226-7055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TADIC",
        "first_name": "COURTNEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100733660",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Supported Choices, LLC
• Daniel P Sutton, PT
• Darby Swan, CD
• Lacey Sweigart, MD
• Synergy Psychiatry and Wellness, PLLC
• Carla Talavera, CADC
• Allan Wei Tao, PHARMD
• Ashley Taylor, ATC
• Jordyn Cheyenne Taylor, APRN
• Justin Vaughn Taylor, PHARMD

• Physician Assistant in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.