NPIMap

Organization Active NPI

Kentucky Hospital LLC

Doing business as Clark Regional Family Practice

  • Family Medicine Physician
  • Winchester, KY
National Provider Identifier
1831418060
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KENTUCKY HOSPITAL LLC
Doing business as
Clark Regional Family Practice
Practice address
120 Professional Ave
Winchester, KY 40391-1116
Phone
(859) 744-2485
Fax
(859) 744-0062
NPI assigned
May 27, 2010
Last updated
Apr 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Authorized official

Name
Terrance Dillon
Title
Assistant Secretary
Phone
(502) 596-7220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

120 Professional Ave
Winchester, KY 40391-1116

Mailing address

120 Professional Ave
Winchester, KY 40391-1116
Phone (859) 744-2485

Other names 1

  • Clark Regional Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100811000003 KY Part B Supplier - Clinic/Group Practice 4688614290 Receives reassigned benefits from 15 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winchester, KY; Stanton, KY

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

1 Hospital Dr
Winchester, KY 40391
Phone (859) 745-3500

120 Professional Ave
Unit 120
Winchester, KY 40391

1934 Bypass Rd
Winchester, KY 40391
Phone (859) 745-0191

225 Hospital Dr
Ste A
Winchester, KY 40391
Phone (859) 737-6480

225 Hospital Dr
Ste C
Winchester, KY 40391
Phone (859) 737-6480

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1831418060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PROFESSIONAL AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403911116",
            "telephone_number": "859-744-2485",
            "fax_number": "859-744-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PROFESSIONAL AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403911116",
            "telephone_number": "859-744-2485",
            "fax_number": "859-744-0062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "502-596-7220"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Regional Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clark Regional Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.