NPIMap

Organization Active NPI

St. Elizabeth Medical Center, Inc.

Doing business as St. Elizabeth Center for Family Medicine

  • Family Medicine Physician
  • Edgewood, KY
National Provider Identifier
1710001185
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. ELIZABETH MEDICAL CENTER, INC.
Doing business as
St. Elizabeth Center for Family Medicine
Practice address
413 S Loop Rd
Edgewood, KY 41017-5446
Phone
(859) 301-3800
Fax
(859) 301-3987
NPI assigned
Mar 19, 2007
Last updated
Sep 30, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. ELIZABETH MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Authorized official

Name
Timothy Gramann
Title
Director Family Practice Center Adm
Phone
(859) 301-3800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X KY Primary

Addresses

Primary practice location

413 S Loop Rd
Edgewood, KY 41017-5446

Mailing address

413 S Loop Rd
Edgewood, KY 41017-5446
Phone (859) 301-3800

Other names 1

  • St. Elizabeth Center for Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000206 KY Part B Supplier - Clinic/Group Practice 0648174623 Receives reassigned benefits from 290 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edgewood, KY; Erlanger, KY; Falmouth, KY; Florence, KY; Fort Thomas, KY; Hebron, KY; Maysville, KY; Newport, KY…

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0683119St Elizabeth Center for Family Medicine413 South Loop Road, Edgewood, KY 41017Certificate of waiverJul 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Elizabeth Hosp26 organizations share this tax ID, including this one
Part of
St Elizabeth Hosp

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

140 Plaza Dr
Cold Spring, KY 41076
Phone (859) 442-1530

200 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-5900

85 N Grand Ave
Fl 2
Fort Thomas, KY 41075
Phone (859) 781-2628

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1710001185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175446",
            "telephone_number": "859-301-3800",
            "fax_number": "859-301-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175446",
            "telephone_number": "859-301-3800",
            "fax_number": "859-301-3987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. ELIZABETH MEDICAL CENTER, INC.",
        "enumeration_date": "2007-03-19",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "GRAMANN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "DIRECTOR FAMILY PRACTICE CENTER ADM",
        "authorized_official_telephone_number": "859-301-3800"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Elizabeth Center for Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.