Clemente V. Zulueta Jr., MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

36207 Issued in KY

Practice address

95 Jackson HTS
Ste 201
Jackson, KY 41339-6500

Phone

(606) 693-1078

Fax

(606) 693-1079

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Endocrinology

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clemente V. Zulueta, Jr., MD, PLLCGroup PAC ID 2264419811, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kentucky River Medical Center Hospital, Jackson, KY, CCN 181334

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: clementezulueta@121861.advancedmd-direct.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Clemente V. Zulueta, Jr., MD, PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Jackson, KY
  • NPI 1275543175

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

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.

• Clemente V. Zulueta, Jr., MD, PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Jackson, KY
  • NPI 1275543175
  Medicare reassignment Care Compare group NPD Authorized official
• Mitchell Wicker Jr MD PSC

  • Internal Medicine Physician
  • Hazard, KY
  • NPI 1093718116
  NPD (past)
• Mitchell Wicker., Jr., M.D., P.S.C.

  • Internal Medicine Physician
  • Hazard, KY
  • NPI 1629249560
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jackson Hospital Corporation

  • Critical Access Hospital
  • Jackson, KY
  • NPI 1346247962
  Care Compare affiliation

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341187200000",
    "number": "1831109743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 908",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390908",
            "telephone_number": "606-693-1078",
            "fax_number": "606-693-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 JACKSON HTS",
            "address_2": "STE 201",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413396500",
            "telephone_number": "606-693-1078",
            "fax_number": "606-693-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZULUETA",
        "first_name": "CLEMENTE",
        "middle_name": "V.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2012-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "KY",
            "license": "36207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64028400",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Williams
• Wolfe County Clinics
• Dreama Wooton, CDDC,LPCC
• Roger Carl Worthington, D.M.D.
• Daniel Brent Yarbrough

• Endocrinology, Diabetes & Metabolism Physician in Jackson, KY
• Providers in Jackson, KY by specialty
• Endocrinology, Diabetes & Metabolism Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.

Verify at the official NPI Registry.