Active NPI
Mitchael Gene Estridge, M.D.
- Hospitalist Physician
- Lexington, KY
National Provider Identifier
1922038611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 24442
- Practice address
- 1401 Harrodsburg Rd
Suite a-510
Lexington, KY 40504-3751 - Phone
- (859) 258-6784
- Fax
- (859) 258-6796
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 24442 | KY | |
| Hospitalist Physician | 208M00000X | 24442 | KY | Primary |
Addresses
Primary practice location
1401 Harrodsburg Rd
Suite a-510
Lexington, KY 40504-3751
Mailing address
1401 Harrodsburg Rd
Suite a-510
Lexington, KY 40504-3751
Phone (859) 258-6784
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4000501 | Other | KY | MEDICARE LAB GROUP |
| 37903705 | Other | KY | MEDICAID LAB GROUP |
| 64000912 | Medicaid | KY | |
| CB5773 | Other | KY | RAILROAD MEDICARE GROUP |
| 110055339 | Other | KY | RAILROAD MEDICARE PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
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": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1922038611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 HARRODSBURG RD",
"address_2": "SUITE A-510",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405043751",
"telephone_number": "859-258-6784",
"fax_number": "859-258-6796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 HARRODSBURG RD",
"address_2": "SUITE A-510",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405043751",
"telephone_number": "859-258-6784",
"fax_number": "859-258-6796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESTRIDGE",
"first_name": "MITCHAEL",
"middle_name": "GENE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "KY",
"license": "24442",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "KY",
"license": "24442",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE LAB GROUP",
"identifier": "4000501",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID LAB GROUP",
"identifier": "37903705",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64000912",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GROUP",
"identifier": "CB5773",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PIN",
"identifier": "110055339",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.