Carl Lewis Backer, M.D.
Individual provider Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Lexington, KY
NPI 1760477608 · NPPES record last updated Aug 31, 2020
Key facts
- NPI
- 1760477608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- License
- 53982 (KY)
- Practice address
- Uk Healthcare 740 S Limestone Suite A301
Lexington, KY 40536-2991 - Phone
- (859) 323-6494
- Fax
- (859) 257-4682
- NPI assigned
- Sep 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in IL, KY, OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060615000223 | IL | Practitioner - Thoracic Surgery |
7618989567 | Reassigns benefits to 2 organizations |
| I20200521003185 | KY | Practitioner - Cardiac Surgery | 7618989567 | Reassigns benefits to 2 organizations |
| I20200619000710 | OH | Practitioner - Thoracic Surgery | 7618989567 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TP117 | KY | MD | Ophthalmology Physician |
| 036064156 | IL | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| 35.139651 | OH | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockford Health Physicians | Current |
Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| University of Kentucky | Current |
Accepting new patients | |
| CVT Surgeons of Kentucky, PSC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Past |
Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
420 NE Glen Oak Ave
Ste 304
Peoria, IL 61603
Phone (877) 464-6640
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
420 NE Glen Oak Ave
Ste 30
Peoria, IL 61603
2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510
800 Rose St
Lexington, KY 40536
Phone (859) 257-8562
3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225
3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200
3333 Burnet Ave
#2004
Cincinnati, OH 45229
Phone (513) 636-4770
Interoperability endpoints
- cbacker20573@ukhcdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 35.139651 | OH | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | TP117 | KY | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 53982 | KY | Yes |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 036064156 | IL |
Addresses
Primary practice location
Uk Healthcare 740 S Limestone Suite A301
Lexington, KY 40536-2991
Mailing address
3333 Burnet Ave
MLC 2004
Cincinnati, OH 45229-3026
Phone (513) 636-4770
Other practice location 1
3333 Burnet Ave
MLC 2004
Cincinnati, OH 45229-3026
Phone (513) 636-4770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036064156 | Medicaid | IL | |
| 05825879 | Medicaid | MS | |
| 1627123 | Other | IL | BCBS PROVIDER ID |
| 363283051 | Other | IL | OWCP PROVIDER ID |
| 6435508 | Medicaid | KY |
Other providers in Lexington, KY
- Back Talk Chiropractic PSC
- Brittany Bianca Back
- Lia Back
- Treven Back
- W Douglas Back
- Mircea Backhurst
- James David Bacon
- Matthew Keith Bacon
- Ioana Patricia Bacus
- Henrietta Salvilla Bada
All providers in Lexington, KY · Thoracic Surgery (Cardiothoracic Vascular Surgery) 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 Aug 31, 2020. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.