Active NPI
Billy Kevin Clemmons, D.M.D.
- Dentist
- Bowling Green, KY
National Provider Identifier
1871640888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6013
- Practice address
- 1042 Fairview Ave
Suite C
Bowling Green, KY 42103-1677 - Phone
- (270) 746-5880
- Fax
- (270) 746-5944
- NPI assigned
- Jan 4, 2007
- Last updated
- Jun 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6013 | KY | Primary |
Addresses
Primary practice location
1042 Fairview Ave
Suite C
Bowling Green, KY 42103-1677
Mailing address
1099 Denham Rd
Smiths Grove, KY 42171-7261
Phone (270) 597-2643
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60060134 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150521002817 | OH | Order and Referring Only - Dentist | 7911227525 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6013 | KY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Briarwood Dental Partners, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Precision Dental Briarwood
- Dental Clinic/Center
- Bowling Green, KY
- NPI 1295507721
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434326400000",
"number": "1871640888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1099 DENHAM RD",
"city": "SMITHS GROVE",
"state": "KY",
"postal_code": "421717261",
"telephone_number": "270-597-2643",
"fax_number": "270-746-5944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1042 FAIRVIEW AVE",
"address_2": "SUITE C",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421031677",
"telephone_number": "270-746-5880",
"fax_number": "270-746-5944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMMONS",
"first_name": "BILLY",
"middle_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2015-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "6013",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60060134",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.