NPIMap

Organization Active NPI

Family Care of Northern Kentucky, PLLC

Doing business as Premier Family Medicine

  • Family Medicine Physician
  • Edgewood, KY
National Provider Identifier
1952334054
Registry record updated Sep 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY CARE OF NORTHERN KENTUCKY, PLLC
Doing business as
Premier Family Medicine
Practice address
830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Phone
(859) 341-5757
Fax
(859) 331-4757
NPI assigned
Jul 9, 2006
Last updated
Sep 21, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2007

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

Authorized official

Name
Dr. Gregory P Weckenbrock, MDNPI 1265459838
Title
Partner
Phone
(859) 341-5757

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102

Mailing address

830 Thomas More Pkwy
Ste 203
Edgewood, KY 41017-5102
Phone (859) 341-5757

Other identifiers 2

IdentifierTypeStateIssuer
65944027MedicaidKY
2622871MedicaidOH

Other names 1

  • Premier Family Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

830 Thomas More Pkwy
#203
Edgewood, KY 41017

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1952334054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 THOMAS MORE PKWY",
            "address_2": "STE 203",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175102",
            "telephone_number": "859-341-5757",
            "fax_number": "859-331-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 THOMAS MORE PKWY",
            "address_2": "STE 203",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410175102",
            "telephone_number": "859-341-5757",
            "fax_number": "859-331-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE OF NORTHERN KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "WECKENBROCK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "859-341-5757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65944027",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2622871",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.