NPIMap

Individual provider Active NPI

Jacob William Vincent, MD

  • Family Medicine Physician
  • Bardstown, KY
National Provider Identifier
1629075692
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34239 Issued in KY
Practice address
3615 E John Rowan Blvd Ste 104
Bardstown, KY 40004-3264
Phone
(502) 348-5968
Fax
(270) 706-5802
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34239 KY Primary

Addresses

Primary practice location

3615 E John Rowan Blvd Ste 104
Bardstown, KY 40004-3264

Mailing address

3615 E John Rowan Blvd Ste 104
Bardstown, KY 40004-3264
Phone (502) 348-5968

Other identifiers 1

IdentifierTypeStateIssuer
64014111MedicaidKY

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
I20091219000002 KY Practitioner - Family Practice 1557401742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, shared by 31 NPIs, 2,431 clinicians

Practice addresses (Care Compare)

3615 E John Rowan Blvd
Suite 104
Bardstown, KY 40004-3264
Phone (502) 348-5968

96 Future Dr
Corbin, KY 40701-8988
Phone (606) 528-0305

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34239KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Mar 1, 2023 Accepting new patients
Baptist Health Medical Group Inc Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Sep 1, 2020 Accepting new patients

Locations

3615 E John Rowan Blvd
Ste 104
Bardstown, KY 40004
Phone (502) 331-4734

96 Future Dr
Corbin, KY 40701

913 N Dixie Ave
Elizabethtown, KY 42701
Phone (270) 706-1212

2603 Kentucky Ave
Ste 304
Paducah, KY 42003
Phone (270) 415-4800

Organizations & group practices 3

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1629075692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 E JOHN ROWAN BLVD STE 104",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400043264",
            "telephone_number": "502-348-5968",
            "fax_number": "270-706-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 E JOHN ROWAN BLVD STE 104",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400043264",
            "telephone_number": "502-348-5968",
            "fax_number": "270-706-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "JACOB",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "34239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64014111",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bardstown, KY

Sources for this page

Verify at the official NPI Registry.