Individual provider Active NPI

Cynthia Diane Hudson, PT, MS, OCS

  • Physical Therapist
  • Bowling Green, KY
National Provider Identifier
1689739963
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
003058 Issued in KY
Practice address
165 Natchez Trace Ave Ste 200
Bowling Green, KY 42103-7947
Phone
(270) 796-4698
Fax
(270) 782-3274
NPI assigned
Dec 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 003058 KY Primary

Addresses

Primary practice location

165 Natchez Trace Ave Ste 200
Bowling Green, KY 42103-7947

Mailing address

201 Park St
Bowling Green, KY 42101-1742
Phone (270) 796-4698

Other identifiers 2

IdentifierTypeStateIssuer
611273988OtherKYFACILITY TAX ID
000000314785OtherKYANTHEM PROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050617000873 KY Practitioner - Physical Therapist in Private Practice 2567406747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Louisville School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graves Gilbert Clinic PLLCGroup PAC ID 4082511167, 207 clinicians

Practice addresses (Care Compare)

165 Natchez Trace Ave
Bowling Green, KY 42103-7940
Phone (270) 782-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
003058KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Graves Gilbert Clinic PLLC CurrentSince Jul 28, 2016 Accepting new patients
Graves Gilbert Clinic PLLC Physical Therapist CurrentSince Jul 28, 2016 Accepting new patients

Locations

165 Natchez Trace Ave
Ste 200
Bowling Green, KY 42103
Phone (270) 782-7800

201 Park St
Bowling Green, KY 42101
Phone (270) 651-2229

165 Natchez Trace Ave
Bowling Green, KY 42103
Phone (270) 782-7800

165 Natchez Trace Ave
Ste 100
Bowling Green, KY 42103
Phone (270) 782-7800

1330 N Race St
Ste 1
Glasgow, KY 42141
Phone (270) 629-2780

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1689739963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011742",
            "telephone_number": "270-796-4698",
            "fax_number": "270-782-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 NATCHEZ TRACE AVE STE 200",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037947",
            "telephone_number": "270-796-4698",
            "fax_number": "270-782-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "CYNTHIA",
        "middle_name": "DIANE",
        "credential": "PT, MS, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "003058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY TAX ID",
            "identifier": "611273988",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000314785",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.