NPIMap

Individual provider Active NPI

Jeremy C Klein

  • Family Medicine Physician
  • Louisa, KY
National Provider Identifier
1922178052
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31770 Issued in KY
Practice address
40 Medical HTS
Louisa, KY 41230-9603
Phone
(606) 638-0033
NPI assigned
Nov 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31770 KY Primary

Addresses

Primary practice location

40 Medical HTS
Louisa, KY 41230-9603

Mailing address

PO Box 730
Louisa, KY 41230-0730
Phone (606) 638-0033

Other identifiers 3

IdentifierTypeStateIssuer
64317704MedicaidKY
000000056832OtherKYANTHEM BC BS
0056859000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090204000083 KY Practitioner - Family Practice 6507920634 Practice locations: Louisa, KY

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Maryland School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

40 Medical Heights
Louisa, KY 41230-9603
Phone (606) 638-0033

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31770KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital of Louisa, Inc. Past Accepting new patients
Family Practice of Louisa, PLLC PastSince Jul 2, 2012 Accepting new patients
Three Rivers Medical Clinics Inc Past Accepting new patients
McKenzie Health Care, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kjeremy@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Jordan CenterLouisa, KY, CCN 185131 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 31, 2012
Dec 31, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922178052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 730",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412300730",
            "telephone_number": "606-638-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MEDICAL HTS",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412309603",
            "telephone_number": "606-638-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "JEREMY",
        "middle_name": "C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "31770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64317704",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC BS",
            "identifier": "000000056832",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056859000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisa, KY

Sources for this page

Verify at the official NPI Registry.