Active NPI
Charlen Fry, MD
- Family Medicine Physician
- Fort Knox, KY
National Provider Identifier
1891763835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 38012
- Practice address
- 200 Brule St BLDG 871
Fort Knox, KY 40121-6100 - Phone
- (502) 626-9745
- NPI assigned
- Mar 8, 2006
- Last updated
- Jun 15, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 38012 | KY | Primary |
Addresses
Primary practice location
200 Brule St BLDG 871
Fort Knox, KY 40121-6100
Mailing address
PO Box 2309
Elizabethtown, KY 42702-2309
Phone (270) 706-1131
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00081750 | Other | KY | RAILROAD MCR |
| 64067952 | Medicaid | KY | |
| 000000300289 | Other | KY | BC/BS PIN |
| 2443136000 | Other | KY | PASSPORT ADVANTAGE |
| 50001558 | Other | KY | PASSPORT |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140618001535 | KY | Order and Referring Only - Family Practice | 7416171236 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686787200000",
"number": "1891763835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2309",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427022309",
"telephone_number": "270-706-1131",
"fax_number": "270-706-1167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BRULE ST BLDG 871",
"city": "FORT KNOX",
"state": "KY",
"postal_code": "401216100",
"telephone_number": "502-626-9745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRY",
"first_name": "CHARLEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-08",
"last_updated": "2023-06-15",
"certification_date": "2023-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "38012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MCR",
"identifier": "P00081750",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64067952",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS PIN",
"identifier": "000000300289",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT ADVANTAGE",
"identifier": "2443136000",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "50001558",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Knox, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.