Unknown Individual – Family Medicine Physician, NPI 1033280607
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2012-02-20. Reason: License revocation, suspension, or surrender.
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
426, Oak Street, Richmond, Madison County, Kentucky, 40475, United States
RICHMOND, KY 404751312
Phone: (859) 624-5222
Type: Mailing
125, Clay Drive, Berea, Madison County, Kentucky, 40403, United States
BEREA, KY 404031349
Phone: (859) 985-8426
Fax: (859) 985-8747
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 40475)
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