NPIMap

Organization Active NPI

Prodigy Office Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Corbin, KY
National Provider Identifier
1639950140
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
PRODIGY OFFICE ANESTHESIA, LLC
Practice address
1710 Cumberland Falls Hwy
Corbin, KY 40701-2727
Phone
(606) 528-6700
NPI assigned
Oct 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Benjamin T. Small, CRNANPI 1689821076
Title
Organizer
Phone
(304) 741-4957

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

1710 Cumberland Falls Hwy
Corbin, KY 40701-2727

Mailing address

917 Country Oaks Dr
Richmond, KY 40475-8492
Phone (304) 741-4957

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240117004429 KY Part B Supplier - Clinic/Group Practice 8921450776 Receives reassigned benefits from 12 practitioners
Practice locations: Corbin, KY

National Provider Directory

National Provider Directory

Locations

1710 Cumberland Falls Hwy
Corbin, KY 40701
Phone (606) 528-6700

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1639950140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 COUNTRY OAKS DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404758492",
            "telephone_number": "304-741-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 CUMBERLAND FALLS HWY",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012727",
            "telephone_number": "606-528-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY OFFICE ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "304-741-4957",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corbin, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.