NPIMap

Organization Active NPI

Primary Care of the Bluegrass, LLC

Doing business as Crab Orchard Primary Care

  • Primary Care Clinic/Center
  • Crab Orchard, KY
National Provider Identifier
1942463096
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
700193 Issued in KY
Legal business name
PRIMARY CARE OF THE BLUEGRASS, LLC
Doing business as
Crab Orchard Primary Care
Practice address
29 Main St
Crab Orchard, KY 40419-6548
Phone
(606) 355-7800
Fax
(606) 355-7803
NPI assigned
Jul 9, 2008
Last updated
Sep 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
Brittany Underwood, DO
Title
Credentialing Agent
Phone
(859) 303-8746

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 700193 KY Primary
Rural Health Clinic/Center 261QR1300X 900266 KY
Nurse Practitioner 363L00000X

Addresses

Primary practice location

29 Main St
Crab Orchard, KY 40419-6548

Mailing address

1031 Wellington Way Ste 240
Lexington, KY 40513-1257
Phone (859) 303-8746

Other identifiers 1

IdentifierTypeStateIssuer
7100043870MedicaidKY

Other names 1

  • CRAB ORCHARD PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080924000350 KY Part B Supplier - Clinic/Group Practice 4183791700 Receives reassigned benefits from 25 practitioners
Practice locations: Crab Orchard, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1942463096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 WELLINGTON WAY STE 240",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131257",
            "telephone_number": "859-303-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 MAIN ST",
            "city": "CRAB ORCHARD",
            "state": "KY",
            "postal_code": "404196548",
            "telephone_number": "606-355-7800",
            "fax_number": "606-355-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF THE BLUEGRASS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "859-303-8746",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": "700193",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900266",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100043870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRAB ORCHARD PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CRAB ORCHARD PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crab Orchard, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.