Active NPI
Joseph M O'Bryan, MD
- Family Medicine Physician
- Paducah, KY
National Provider Identifier
1770570400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36713
- Practice address
- 5120 Village Square Dr
Suite 103
Paducah, KY 42001-9060 - Phone
- (270) 442-0240
- Fax
- (270) 442-9599
- NPI assigned
- Sep 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 36713 | KY | |
| Family Medicine Physician | 207Q00000X | 01044033A | IN | |
| Family Medicine Physician | 207Q00000X | 36713 | KY | Primary |
Addresses
Primary practice location
5120 Village Square Dr
Suite 103
Paducah, KY 42001-9060
Mailing address
PO Box 9150
Paducah, KY 42002-9150
Phone (270) 744-9600
Other practice location 1
426 S Alabama St Ste 100
Indianapolis, IN 46225-3301
Phone (317) 528-2486
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64880495 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5120 Village Square Dr
Suite 103
Paducah, KY 42001-9560
Phone (270) 442-0240
Hospital & facility affiliations
- Baptist Health Paducah
- Mercy Health - Lourdes Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36713 | KY | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Baptist Medical Ventures, Inc. | Past | Accepting new patients | |
| Jackson Purchase ER Physicians, PSC | Emergency Medicine | Past | Accepting new patients |
| St. Mary'S Health, Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Paducah, KY
- NPI 1235367442
-
- Emergency Medicine Physician
- Paducah, KY
- NPI 1093701823
-
- Neurological Surgery Physician
- Paducah, KY
- NPI 1316017080
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Paducah, KY
- NPI 1730264128
-
- General Acute Care Hospital
- Paducah, KY
- NPI 1346244126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587945600000",
"number": "1770570400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9150",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420029150",
"telephone_number": "270-744-9600",
"fax_number": "270-744-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5120 VILLAGE SQUARE DR",
"address_2": "SUITE 103",
"city": "PADUCAH",
"state": "KY",
"postal_code": "420019060",
"telephone_number": "270-442-0240",
"fax_number": "270-442-9599"
}
],
"practiceLocations": [
{
"address_1": "426 S Alabama St Ste 100",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462253301",
"country_code": "US",
"telephone_number": "317-528-2486",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "O'BRYAN",
"first_name": "JOSEPH",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-27",
"last_updated": "2020-04-27",
"certification_date": "2020-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "KY",
"license": "36713",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01044033A",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "36713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64880495",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paducah, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.