Melissa Boucher Dennison, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

KY28593 Issued in KY

Practice address

301 Professional Park Dr
Glasgow, KY 42141-3487

Phone

(270) 651-9696

Fax

(270) 651-0385

NPI assigned

Nov 22, 2005

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: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cumberland Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Burkesville, KY
  • NPI 1306873500
  Medicare reassignment NPD
• Cumberland Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Edmonton, KY
  • NPI 1548953672
  NPD
• Cumberland Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Danville, KY
  • NPI 1215918917
  NPD (past)
• Glasgow Pediatric Associates, PSC

  • Pediatrics Physician
  • Greensburg, KY
  • NPI 1730411562
  NPD (past)

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1659354892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-864-1472",
            "fax_number": "270-864-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PROFESSIONAL PARK DR",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421413487",
            "telephone_number": "270-651-9696",
            "fax_number": "270-651-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNISON",
        "first_name": "MELISSA",
        "middle_name": "BOUCHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "KY28593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64285935",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Amber Davis
• Andrea Berry Deckard, PTA
• Camila Del Valle-Hernandez
• Nancy Dennis, CASE MANAGER
• Ollie Charles Dennis, M. A., ED. D
• Boston Hunter Devore, PTA
• Diabetic Footwear Associates
• Melonee Grace Dickson
• Harlan Louis Dile, FNP-C
• Taylor Brooke Dillingham

• Pediatrics Physician in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.