Individual provider Active NPI

Preston Jude Middleton, LCSW

  • Clinical Social Worker
  • Prestonsburg, KY
National Provider Identifier
1962049171
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
257831 Issued in KY
Practice address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone
(606) 886-8572
Fax
(606) 886-4433
NPI assigned
Dec 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 9186 KY
Clinical Social Worker 1041C0700X 257831 KY Primary

Addresses

Primary practice location

104 S Front Ave
Prestonsburg, KY 41653-1614

Mailing address

829 E Byers Ave
Owensboro, KY 42303-8820
Phone (270) 314-7851

Other practice location 1

829 E Byers Ave
Owensboro, KY 42303-8820
Phone (270) 314-7851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230427002638 KY Practitioner - Clinical Social Worker 1850756735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-4346

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
257831KYMDClinical Social Worker
9186KYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Comprehensive Care Center, Inc. Current Accepting new patients
Mountain Comprehensive Care Center, Inc. CurrentSince Apr 12, 2023 Accepting new patients
Mountain Comprehensive Care Center, Inc. CurrentSince Apr 12, 2023 Accepting new patients

Locations

1110 S Mayo Trl
Paintsville, KY 41240
Phone (606) 788-1345

838 S Mayo Trl
Paintsville, KY 41240
Phone (606) 788-1345

104 S Front Ave
Prestonsburg, KY 41653
Phone (606) 688-6857

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": "1575590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1962049171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 E BYERS AVE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423038820",
            "telephone_number": "270-314-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 E Byers Ave",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423038820",
            "country_code": "US",
            "telephone_number": "270-314-7851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIDDLETON",
        "first_name": "PRESTON",
        "middle_name": "JUDE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-06",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "KY",
            "license": "9186",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "257831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.