NPIMap

Organization Active NPI

Northern Kentucky Heart PSC

  • Cardiovascular Disease Physician
  • Crestview Hills, KY
National Provider Identifier
1700879491
Registry record updated Oct 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
NORTHERN KENTUCKY HEART PSC
Practice address
380 Centre View Blvd
Crestview Hills, KY 41017-3476
Phone
(859) 341-3015
Fax
(859) 341-3215
NPI assigned
Aug 26, 2005
Last updated
Oct 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2010

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

Authorized official

Name
Patrick Gerak
Title
Chief Operation Officer
Phone
(859) 341-3015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

380 Centre View Blvd
Crestview Hills, KY 41017-3476

Mailing address

380 Centre View Blvd
Crestview Hills, KY 41017-3476
Phone (859) 341-3015

Other identifiers 2

IdentifierTypeStateIssuer
65939522MedicaidKY
78903259MedicaidKY

National Provider Directory

National Provider Directory

Locations

525 Alexandria Pike
Ste 330
Southgate, KY 41071
Phone (859) 341-3015

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1700879491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 CENTRE VIEW BLVD",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173476",
            "telephone_number": "859-341-3015",
            "fax_number": "859-341-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 CENTRE VIEW BLVD",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173476",
            "telephone_number": "859-341-3015",
            "fax_number": "859-341-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN KENTUCKY HEART PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-26",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "GERAK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CHIEF OPERATION OFFICER",
        "authorized_official_telephone_number": "859-341-3015"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65939522",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78903259",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.