Individual provider Active NPI

John Lee McDonough, M.D.

  • Obstetrics & Gynecology Physician
  • Fort Campbell, KY
National Provider Identifier
1932168275
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
11938 Issued in AL
Practice address
650 Joel Dr
Fort Campbell, KY 42223
Phone
(334) 464-2497
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 11938 AL
Obstetrics & Gynecology Physician 207V00000X 11938 AL Primary

Addresses

Primary practice location

650 Joel Dr
Fort Campbell, KY 42223

Mailing address

650 Joel Dr
Fort Campbell, KY 42223-5318
Phone (270) 798-8148

Other practice location 1

650 Joel Dr
Fort Campbell, KY 42223
Phone (334) 464-2497

Other identifiers 2

IdentifierTypeStateIssuer
38853OtherALBCBS PROVIDER NUMBER
000038853MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200116001298 VA Practitioner - Obstetrics/Gynecology 5597868547 Reassigns benefits to 1 organization
I20220328000330 TX Practitioner - Obstetrics/Gynecology 5597868547 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11938ALMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinch Valley Physicians Associates LLC Obstetrics & Gynecology CurrentSince Jan 1, 2020 Accepting new patients
Clinch Valley Physicians Associates LLC CurrentSince Jan 1, 2020 Accepting new patients
Obhg Texas Holdings, P.a. Obstetrics & Gynecology CurrentSince Dec 16, 2021 Accepting new patients

Locations

777 Lowndes Hill Rd
Bldg 1
Greenville, SC 29607
Phone (864) 908-3736

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (321) 917-9263

3333 Research Plz
San Antonio, TX 78235
Phone (210) 297-3000

398 Clinic Rd
Cedar Bluff, VA 24609
Phone (276) 963-6600

Interoperability endpoints

  • Direct secure messaging: john.mcdonough@vab.hcadirect.net
  • FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1932168275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "42223",
            "telephone_number": "334-464-2497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Joel Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Campbell",
            "state": "KY",
            "postal_code": "42223",
            "country_code": "US",
            "telephone_number": "334-464-2497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONOUGH",
        "first_name": "JOHN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "11938",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AL",
            "license": "11938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "38853",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000038853",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

Verify at the official NPI Registry.