Millard Lynn Fogleman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

33564 Issued in KY

Practice address

53 Queendale Ctr
Red Bird Clinic
Beverly, KY 40913-9607

Phone

(606) 598-5135

Fax

(606) 598-8942

NPI assigned

Sep 22, 2005

Sex

Male

Sole proprietor

No

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.

• Red Bird Clinic, Inc.

  • Dental Clinic/Center
  • Beverly, KY
  • NPI 1821084971
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 28, 2011.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1790771046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 QUEENDALE CTR",
            "address_2": "RED BIRD CLINIC",
            "city": "BEVERLY",
            "state": "KY",
            "postal_code": "409139607",
            "telephone_number": "606-598-5135",
            "fax_number": "606-598-8942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 QUEENDALE CTR",
            "address_2": "RED BIRD CLINIC",
            "city": "BEVERLY",
            "state": "KY",
            "postal_code": "409139607",
            "telephone_number": "606-598-5135",
            "fax_number": "606-598-8942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGLEMAN",
        "first_name": "MILLARD",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "33564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64057094",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Kay Goodwin Fogleman, MD
• Aaron N. Frye, APRN, FNP-BC
• Memorial Hospital Inc
• Memorial Hospital, Inc.
• Bruce D. Polly, RPH

• All providers in Beverly, KY
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.