NPIMap

Individual provider Active NPI

William Deadrick Kirk, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
National Provider Identifier
1972595270
Registry record updated Dec 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
26011 Issued in KY
Practice address
312 W High St
Lebanon, KY 40033-1428
Phone
(270) 692-9559
Fax
(270) 692-9236
NPI assigned
Aug 22, 2005
Last updated
Dec 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 26011 KY Primary

Addresses

Primary practice location

312 W High St
Lebanon, KY 40033-1428

Mailing address

312 W High St
Lebanon, KY 40033-1428
Phone (270) 692-9559

Other identifiers 1

IdentifierTypeStateIssuer
64260110MedicaidKY

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
I20040415000003 KY Practitioner - Internal Medicine 0446245096 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
William D. Kirk M.D., PLLCGroup PAC ID 3173794740, 3 clinicians

Practice addresses (Care Compare)

312 W High St
Lebanon, KY 40033-1428
Phone (270) 692-9559

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy28
Upper gastrointestinal (GI) endoscopy for acid reflux13
Removal of skin lesions16
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26011KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William D. Kirk M.D., PLLC Internal Medicine CurrentSince Jul 1, 1989 Accepting new patients
Marshall Emergency Services Associates, PLLC Past Accepting new patients

Locations

312 W High St
Lebanon, KY 40033
Phone (270) 692-0110

320 N Loretto Rd
Lebanon, KY 40033
Phone (270) 692-3161

Interoperability endpoints

  • Direct secure messaging: william.kirk.1@16364.direct.athenahealth.com
  • Direct secure messaging: william.kirk.1@30070.direct.athenahealth.com

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1972595270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W HIGH ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331428",
            "telephone_number": "270-692-9559",
            "fax_number": "270-692-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W HIGH ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331428",
            "telephone_number": "270-692-9559",
            "fax_number": "270-692-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRK",
        "first_name": "WILLIAM",
        "middle_name": "DEADRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "26011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64260110",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, KY

Sources for this page

Verify at the official NPI Registry.