Elite Physical Medicine LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

ELITE PHYSICAL MEDICINE LLC

Practice address

2091 N Bend Rd Ste 100
Hebron, KY 41048-9122

Phone

(859) 544-2421

NPI assigned

Apr 21, 2020

Organization subpart

No

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

Authorized official

Name

David Segraves

Title

Ceo

Phone

(859) 544-2421

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyler Church, M.D.

  • Anesthesiology Physician
  • Gilbert, AZ
  • NPI 1487837159
  NPD (past)

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1730709601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2091 N BEND RD",
            "city": "HEBRON",
            "state": "KY",
            "postal_code": "410489691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 N BEND RD STE 100",
            "city": "HEBRON",
            "state": "KY",
            "postal_code": "410489122",
            "telephone_number": "859-544-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-21",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "SEGRAVES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "859-544-2421"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crestville Drugs Inc
• Suesana Denton, COTA
• Dhda Hebron, PLLC
• Dr. Thomas C. Noyes, PHD
• Michael Kevin Dragan, MD
• Epoch Wellness LLC
• First Achievements,PLLC
• Mark E Franklin, MD
• Christine Gibson, M.T.
• Julie Graessle, RN

• Interventional Pain Medicine Physician in Hebron, KY
• Providers in Hebron, KY by specialty
• Interventional Pain Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.