NPIMap

Organization Active NPI

Southern Kentucky Nephrology Associates PSC

  • Nephrology Physician
  • Bowling Green, KY
National Provider Identifier
1740310267
Registry record updated Feb 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
SOUTHERN KENTUCKY NEPHROLOGY ASSOCIATES PSC
Practice address
720 2ND Ave
Suite 203
Bowling Green, KY 42101-1778
Phone
(270) 745-1230
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2018

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

Authorized official

Name
Misty Smith
Title
Practice Manager
Phone
(270) 843-5114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

720 2ND Ave
Suite 203
Bowling Green, KY 42101-1778

Mailing address

720 2ND Ave
Suite 203
Bowling Green, KY 42101-1778
Phone (270) 843-5114

Other identifiers 1

IdentifierTypeStateIssuer
6592215500MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050816000173 KY Part B Supplier - Clinic/Group Practice 4183654643 Receives reassigned benefits from 12 practitioners
Practice locations: Bowling Green, KY

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
18D0688541Southern Kentucky Nephrology Associates720 E Second Avenue Suite 203, Bowling Green, KY 42101Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southern Kentucky Neph As2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

720 2nd Ave
Ste 203
Bowling Green, KY 42101
Phone (270) 843-5114

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1740310267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 2ND AVE",
            "address_2": "SUITE 203",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011778",
            "telephone_number": "270-843-5114",
            "fax_number": "270-745-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 2ND AVE",
            "address_2": "SUITE 203",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011778",
            "telephone_number": "270-745-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN KENTUCKY NEPHROLOGY ASSOCIATES PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "270-843-5114"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6592215500",
            "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 Feb 1, 2018; 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.