Kevin Pettus, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41148 Issued in KY

Practice address

7786 Lexington Rd
Lancaster, KY 40444-9119

Phone

(859) 548-4114

Fax

(859) 548-2718

NPI assigned

Nov 30, 2006

Last updated

Jul 31, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Commonhealth LLCGroup PAC ID 2163833476, 6 clinicians

Gim of Kentucky PLLCGroup PAC ID 5294036521, 5 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Commonhealth LLC

  dba CommonHealth Recovery

  • Addiction Medicine (Family Medicine) Physician
  • Frankfort, KY
  • NPI 1902425515
  Medicare reassignment Care Compare group NPD
• Gim of Kentucky PLLC

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1326411026
  Medicare reassignment Care Compare group
• 24 On Physicians, PC

  • Hospitalist Physician
  • Danville, KY
  • NPI 1679522346
  Medicare reassignment NPD
• Hospital Medicine Services of Tennessee PC

  • Hospitalist Physician
  • Lawrenceburg, IN
  • NPI 1528433802

  Family Medicine, KY

  Medicare reassignment NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  KY

  Medicare reassignment NPD
• 4Seeds Medical Clinic, PLLC

  • Primary Care Clinic/Center
  • Lancaster, KY
  • NPI 1467690198
  Authorized official Same address or phone
• 24 On Physicians, P.C.

  • Hospitalist Physician
  • Attleboro, MA
  • NPI 1790104511
  NPD
• Bluegrass Clinic Liberty, PLLC

  • Family Medicine Physician
  • Liberty, KY
  • NPI 1457555146

  Legal Medicine

  NPD (past)
• Commonhealth LLC

  dba CommonHealth Recovery

  • Rural Health Clinic/Center
  • Frankfort, KY
  • NPI 1710821525
  NPD (past)
• Marshall Emergency Services Associates, PLLC

  • Emergency Medicine Physician
  • Lexington, KY
  • NPI 1891737185
  NPD (past)

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248998400000",
    "number": "1679641609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2185",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404232185",
            "telephone_number": "859-548-4114",
            "fax_number": "859-548-2718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7786 LEXINGTON RD",
            "city": "LANCASTER",
            "state": "KY",
            "postal_code": "404449119",
            "telephone_number": "859-548-4114",
            "fax_number": "859-548-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2009-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "KY",
            "license": "41148",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01056257A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "41148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-BGC STANFORD PLLC",
            "identifier": "000000536447",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-BGC LIBERTY, PLLC",
            "identifier": "000000536458",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-STANFORD FAMILY MED",
            "identifier": "000000536456",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• New Vista of the Bluegrass Inc
• Donja Nicole Newman
• Jo Ann Noel, RN
• Melanie Grey Parsons
• Dev Patel, DMD
• Primary Care of the Bluegrass (Bryantsville Primary Care)
• Danielle Purcell
• Srinivas B Rapuri, MD
• Reflections Wellness and Recovery
• Candace E. Robinson, C.P.M.

• Family Medicine Physician in Lancaster, KY
• Providers in Lancaster, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; 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.