NPIMap

Organization Active NPI

Berea Urgent Care LLC

  • Nurse Practitioner
  • Berea, KY
National Provider Identifier
1912054792
Registry record updated May 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
BEREA URGENT CARE LLC
Practice address
234 Brenwood St
Berea, KY 40403-1637
Phone
(859) 985-0302
Fax
(859) 985-0308
NPI assigned
Jan 4, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Nawar SodaNPI 1083812598
Title
Partner
Phone
(859) 985-0302

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 81

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1046850Berea Urgent Care234 Brenwood Drive, Berea, KY 40403Certificate of waiverOct 19, 2027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060111001073 KY Part B Supplier - Clinic/Group Practice 2567485949 Receives reassigned benefits from 79 practitioners
Practice locations: Berea, KY

National Provider Directory

National Provider Directory

Locations

234 Brenwood St
Berea, KY 40403
Phone (859) 985-0302

2008 Merchant Dr
Ste 2
Richmond, KY 40475

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

234 Brenwood St
Berea, KY 40403-1637

Mailing address

234 Brenwood St
Berea, KY 40403-1637
Phone (859) 985-0302

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
18D1046850OtherKYCLIA
65944373MedicaidKY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 12, 2016.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1912054792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 BRENWOOD ST",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "404031637",
            "telephone_number": "859-985-0302",
            "fax_number": "859-985-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 BRENWOOD ST",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "404031637",
            "telephone_number": "859-985-0302",
            "fax_number": "859-985-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEREA URGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "SODA",
        "authorized_official_first_name": "NAWAR",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "859-985-0302"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "18D1046850",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65944373",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berea, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.