NPIMap

Individual provider Active NPI

Bernard Theodore Botiller, PA-C

  • Physician Assistant
National Provider Identifier
1588674865
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA674 Issued in KY
Practice address
1451 Harrodsburg Road
Suite D 304
Lexington, KY 40504
UM
Phone
(859) 977-4000
Fax
(859) 977-5100
NPI assigned
Aug 9, 2006
Last updated
May 24, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

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 PA674 KY Primary
Medical Physician Assistant 363AM0700X PA674 KY

Addresses

Primary practice location

1451 Harrodsburg Road
Suite D 304
Lexington, KY 40504
UM

Mailing address

6400 Dutchmans Pkwy
Suite 250
Louisville, KY 40205-3340
Phone (502) 587-9660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040223000064 KY Practitioner - Physician Assistant 8628964210 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Kentucky Kidney Care LLCGroup PAC ID 2769927458, 4 clinicians

Practice addresses (Care Compare)

1038 Burlington LN B
Frankfort, KY 40601-8484
Phone (859) 235-6300

1451 Harrodsburg Rd
Suite D304
Lexington, KY 40504-3773
Phone (859) 235-6300

150 War Admiral
Suite 4
Danville, KY 40422-8690
Phone (859) 235-6300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA674KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kentucky CurrentSince Feb 25, 2015 Accepting new patients
Roach Fisher and Roach PLLC PastSince Jul 1, 1999 Accepting new patients
Anderson Family Health Care, PLLC Past Accepting new patients

Locations

464 Linden Ave
Harrodsburg, KY 40330
Phone (859) 734-5441

1451 Harrodsburg Rd
Ste D304
Lexington, KY 40504
Phone (859) 317-1673

150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

6400 Dutchmans Pkwy
Ste 250
Louisville, KY 40205
Phone 5025879660239

Organizations & group practices 5

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1588674865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053340",
            "telephone_number": "502-587-9660",
            "fax_number": "502-540-5615"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "1451 HARRODSBURG ROAD",
            "address_2": "SUITE D 304",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40504",
            "telephone_number": "859-977-4000",
            "fax_number": "859-977-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTILLER",
        "first_name": "BERNARD",
        "middle_name": "THEODORE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA674",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.