Active NPI
Kentucky Em-I Medical Services, PSC
- Emergency Medicine Physician
- Prestonsburg, KY
National Provider Identifier
1861691057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- KENTUCKY EM-I MEDICAL SERVICES, PSC
- Practice address
- 5000 Ky Route 321
Prestonsburg, KY 41653-9113 - Phone
- (606) 886-8511
- NPI assigned
- Jul 17, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer Provasnik
- Title
- Supervisor of Provider Enrollment
- Phone
- (800) 355-0808
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary |
Addresses
Primary practice location
5000 Ky Route 321
Prestonsburg, KY 41653-9113
Mailing address
PO Box 42966
Philadelphia, PA 19101-2966
Phone (800) 355-0808
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65930539 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041111000775 | KY | Part B Supplier - Clinic/Group Practice | 8325001175 |
Receives reassigned benefits from 83 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Paducah, KY; Murray, KY; Corbin, KY; Ashland, KY |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Nurse Practitioner
- Bowling Green, KY
- NPI 1083869135
O20041111000775
-
- Emergency Medicine Physician
- Ashland, KY
- NPI 1356848121
O20041111000775
-
- Emergency Medicine Physician
- Murray, KY
- NPI 1740512615
O20041111000775
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1184630400000",
"number": "1861691057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 42966",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191012966",
"telephone_number": "800-355-0808",
"fax_number": "610-834-2862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 KY ROUTE 321",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "416539113",
"telephone_number": "606-886-8511"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KENTUCKY EM-I MEDICAL SERVICES, PSC",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-17",
"last_updated": "2007-07-17",
"status": "A",
"authorized_official_last_name": "PROVASNIK",
"authorized_official_first_name": "JENNIFER",
"authorized_official_title_or_position": "SUPERVISOR OF PROVIDER ENROLLMENT",
"authorized_official_telephone_number": "800-355-0808"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "65930539",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prestonsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.