HENDERSON ORTHOPAEDIC MEDICAL GROUP, PSC (NPI# 1063410884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063410884 |
| Entity Type | Organization |
| Organization Name | HENDERSON ORTHOPAEDIC MEDICAL GROUP, PSC |
| Practice Address |
471 Klutey Park Plaza Dr Henderson KY 42420-3347 |
| Practice Telephone | 2708308032 |
| Practice Fax Number | 2708308132 |
| Mailing Telephone | 2708308032 |
| Mailing Fax Number | 2708308132 |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JACOB M O'NEILL (PRESIDENT) |
| Authorized Official Telephone | 2708308032 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | ========= | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 65927352 | 05 |
| Street Address |
471 KLUTEY PARK PLAZA DR |
| City | HENDERSON |
| State | KY |
| Zip Code | 42420-3347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689671661 | Amy M Herr | Physical Therapist | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2005-07-05 |
| 1104445014 | Deaconess Clinic, Inc | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2020-04-10 |
| 1215491311 | Methodist Health, Inc. | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2019-01-23 |
| 1508351685 | Samuel Gerhardt | Family Medicine | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2018-06-29 |
| 1184036907 | Tri-state Orthopaedic Surgeons, Inc | Orthopaedic Surgery | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2014-05-28 |
| 1962839084 | Emily R Knapp | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2013-10-03 |
| 1306152558 | Shauna J Keys | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2010-08-26 |
| 1346551439 | David Lawford Whitney | Orthopaedic Surgery | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2010-06-23 |
| 1144412479 | Methodist Health, Inc. | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2007-08-10 |
| 1255437463 | Yvonne Maddela Davis | Nurse Practitioner | 471 Klutey Park Plaza Dr, Henderson, KY 42420-3347 | 2006-09-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174136337 | Virtual Consult Md LLC | Psychiatry & Neurology | 2202 Hwy 41 North, Unit E 152, Hendereson, KY 42420 | 2020-08-27 |
| 1679062731 | Maranda Wortham Miles | Nurse Practitioner | 2242 Hwy 41 North, Henderson, KY 42420 | 2018-05-04 |
| 1780124297 | Lisa Lovell | Nurse Practitioner | 230 North Green Street, Henderson, KY 42420 | 2017-03-02 |
| 1437540614 | Kala Hovermale | Social Worker | 220 2nd Street Ste 406, Henderson, KY 42420 | 2015-02-10 |
| 1972991537 | Jessica Thomas | Counselor | 230 Second St, Suite 406, Henderson, KY 42420 | 2015-01-06 |
| 1255690962 | Green River District Health Department | Public Health or Welfare | 631 N. Green Street, Henderson, KY 42420 | 2012-05-15 |
| 1588922769 | Jonathan M Mosley | Family Medicine | 1200 Barrett Blvd, Henderson, KY 42420 | 2012-04-25 |
| 1093099731 | Gregory Ayuk | Pharmacist | 402 Second Street, Henderson, KY 42420 | 2011-09-29 |
| 1437488137 | Peter J. Doll, D.p.m. | Durable Medical Equipment & Medical Supplies | 323 8th St., Henderson, KY 42420 | 2009-12-09 |
| 1760626402 | Linda Dalton Keith | Nurse Practitioner | 1704 2nd St, Henderson, KY 42420 | 2009-04-24 |
| Find all providers in zip 42420 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437531902 | Laura M. Bruse, M.d., P.C. | Orthopaedic Surgery | 1452 W. Horizon Ridge Pkwy #510, Henderson, NV 89012 | 2015-06-22 |
| 1396087623 | Carl Bradley Wallis | Orthopaedic Surgery | 10561 Jeffreys St Ste 230, Henderson, NV 89052-4268 | 2013-03-25 |
| 1124339676 | Mark Allen | Orthopaedic Surgery | 1505 Wigwam Pkwy Ste 330, Henderson, NV 89074 | 2010-06-30 |
| 1447480413 | Private Diagnostic Clinic, Pllc | Orthopaedic Surgery | 511 Ruin Road, Suite 106, Henderson, NC 27536-5919 | 2009-07-23 |
| 1588793533 | Caleb Ogden Pinegar | Orthopaedic Surgery | 2779 W Horizon Ridge Pkwy Ste 200, Henderson, NV 89052-4186 | 2007-03-05 |
| 1033269147 | Michael J Crovetti Jr. | Orthopaedic Surgery | 2779 W. Horizon Ridge Pkwy., Ste. 200, Henderson, NV 89052-4380 | 2007-01-11 |
| 1942243324 | Ronald Curtis Koe | Orthopaedic Surgery | 1710 W. Horizon Ridge Pkwy, Ste 120, Henderson, NV 89012 | 2006-06-14 |
| 1376500181 | Frederick Charles Balduini | Orthopaedic Surgery | 2779 W Horizon Ridge, Ste 200, Henderson, NV 89052-4380 | 2006-04-26 |
| 1104893031 | Frederick Charles Redfern | Orthopaedic Surgery | 1701 N Green Valley Pkwy Ste 4b, Henderson, NV 89074-5886 | 2006-02-28 |
| 1750371233 | John E Herr | Orthopaedic Surgery | 1701 N Green Valley Pkwy Ste 4c, Henderson, NV 89074-5886 | 2005-10-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.