St. Elizabeth Medical Center, Inc.
Organization Active NPI Family Medicine Physician · Edgewood, KY
NPI 1710001185 · NPPES record last updated Sep 30, 2025
Key facts
- NPI
- 1710001185
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ST. ELIZABETH MEDICAL CENTER, INC.
- Practice address
- 413 S Loop Rd
Edgewood, KY 41017-5446 - Phone
- (859) 301-3800
- Fax
- (859) 301-3987
- NPI assigned
- Mar 19, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. ELIZABETH MEDICAL CENTER, INC.
Authorized official
- Name
- Timothy Gramann
- Title
- Director Family Practice Center Adm
- Phone
- (859) 301-3800
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 25
Practitioners 11
-
Mary Ann Barnes, MD
-
Sarah Beth Flora, M.D.
-
Bobbi Omori Lakin, M.D.
-
Allana Oak, DO
-
Jaclyn Replogle, LCSW
-
Donald J Swikert, MD
-
Robert N Tracy, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0683119 | St Elizabeth Center for Family Medicine | Certificate of waiver | Jul 5, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- Charles Stephens MD
- Part of
- Charles Stephens MD
Locations
4341 Winston Ave
Covington, KY 41015
Phone (606) 431-7660
2900 Chancellor Dr
Crestview Hills, KY 41017
Phone (859) 341-0288
413 S Loop Rd
Edgewood, KY 41017
Phone (859) 301-3800
830 Thomas More Pkwy
Fort Mitchell, KY 41017
Phone (859) 301-8686
85 N Grand Ave
Fl 2
Fort Thomas, KY 41075
Phone (859) 781-2628
238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | |||
| Family Medicine Physician |
207Q00000X | KY | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65901688 | Medicaid | KY |
Other names
- St. Elizabeth Center for Family Medicine
Other providers in Edgewood, KY
- St Elizabeth Outpatient Pharmacy
- St. Elizabeth Medical Center, Inc
- St. Elizabeth Medical Center, Inc.
- St. Elizabeth Medical Center, Inc.
- St. Elizabeth Medical Center, Inc.
- St. Elizabeth Medical Center, Inc.
- Austin Stacy
- Christina Staggs
- Wyatt Allen Stahl
- David M Stanforth
All providers in Edgewood, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.