NPIMap

Cumberland Foot and Ankle Centers

Organization Active NPI Orthopaedic Surgery Physician · Somerset, KY

NPI 1780104281 · NPPES record last updated Jun 26, 2017

Key facts

NPI
1780104281
Entity type
Organization (NPI type 2)
Primary specialty
Orthopaedic Surgery Physician 207X00000X
Legal business name
CUMBERLAND FOOT AND ANKLE CENTERS
Practice address
118 Tradepark Dr Ste B
Somerset, KY 42503-3427
Phone
(606) 416-5225
Fax
(606) 416-5386
NPI assigned
Jun 26, 2017
Organization subpart
No

Authorized official

Name
Jonathan E Moore, DPM
Title
Associate Partner/Podiatrist
Phone
(606) 679-2773

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040322000214 KY Part B Supplier - Clinic/Group Practice 4385535319 Receives reassigned benefits from 24 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowling Green, KY; Somerset, KY; Russell Springs, KY; Richmond, KY; Mount Vernon, KY; Monticello, KY; Manchester, KY; London, KY…

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207X00000X Yes
Physical Medicine & Rehabilitation Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208100000X
Foot & Ankle Surgery Podiatrist
Group: 193200000X MULTI-SPECIALTY GROUP		 213ES0103X
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X

Addresses

Primary practice location

118 Tradepark Dr Ste B
Somerset, KY 42503-3427

Mailing address

117 Tradepark Dr Ste B
Somerset, KY 42503-3428
Phone (606) 679-2773

Other identifiers

IdentifierTypeStateIssuer
7100234690MedicaidKY
7100358430MedicaidKY
7100207030MedicaidKY

Other names

  • Cumberland Bone and Joint Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 26, 2017.

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498435200000",
    "number": "1780104281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 TRADEPARK DR STE B",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033428",
            "telephone_number": "606-679-2773",
            "fax_number": "606-679-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 TRADEPARK DR STE B",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033427",
            "telephone_number": "606-416-5225",
            "fax_number": "606-416-5386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FOOT AND ANKLE CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2017-06-26",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ASSOCIATE PARTNER/PODIATRIST",
        "authorized_official_telephone_number": "606-679-2773",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100234690",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100358430",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100207030",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cumberland Bone and Joint",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerset, KY

All providers in Somerset, KY · Orthopaedic Surgery Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.