1. Home
  2. Directory
  3. Kentucky
  4. Somerset
  5. Internal Medicine
  6. NPI Profile

DR. HAROLD HELTON JR. M.D.
NPI 1063404481
Internal Medicine - Nephrology in Somerset, KY

Active since August 22, 2005PECOS EnrolledAccepts Medicare Assignment
65.84/100
CMS Quality Rating
104 HARDIN LN STE A, SOMERSET, KY 42503(606) 678-2063(606) 678-2218 Get Directions Write a Review

NPPES record last updated: June 2, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 23, 2020, Oct 9, 2018 (2 updates tracked since 2018).

About Dr. Harold Helton Jr. M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. HAROLD HELTON JR. M.D. (NPI 1063404481) is an individual nephrology provider in Somerset, Kentucky, licensed in Kentucky (33190) and active in the NPI registry since August 2005. He is enrolled in Medicare PECOS, is affiliated with Lake Cumberland Regional Hospital, and is a graduate of University Of Kentucky College Of Medicine (1996).

NPPES Registry Identity

NPI1063404481
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameDR. HAROLD HELTON JR.Credential: M.D.
Location Address104 HARDIN LN STE ASomerset, KY 42503-3800
Mailing Address104 Hardin Ln Ste ASomerset, KY 42503-3800 · (606) 678-2063 · Fax (606) 678-2218
Phone(606) 678-2063
Fax(606) 678-2218
Sole ProprietorYes
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1996
Enumeration DateAugust 22, 2005
Last NPPES UpdateJune 2, 20222 updates tracked since enumeration
NPPES CertifiedJune 2, 2022
✔ NPI 1063404481 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in KY · 33190
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
104 HARDIN LN STE A, Somerset, KY 42503
Open in Google Maps ↗

Other Identifiers 1

Medicaid64331903KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Harold Helton Jr. M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799753687
PECOS Enrollment IDI20040920000031
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Dialysis services, 4 or more physician visits per month (20 years or older) 90960
Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.
269 services61 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
267 services173 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
164 services63 patients
Hemodialysis procedure with physician evaluation 90935
Hemodialysis is a treatment that uses a machine to filter waste and excess fluid from your blood when your kidneys can't. A physician checks your health before, during, and after the procedure to ensure it's working effectively for you.
78 services34 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
73 services37 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
66 services65 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Lake Cumberland Regional Hospital

Acute Care Hospitals · Somerset, KY
2/5 CMS rating
OwnershipProprietary
CMS Certification Number180132
Location305 Langdon StreetSomerset, KY 42503 · Pulaski County
Emergency services Birthing friendly

Wayne County Hospital

Critical Access Hospitals · Monticello, KY
OwnershipVoluntary non-profit - Private
CMS Certification Number181321
Location166 Hospital StreetMonticello, KY 42633 · Wayne County
Emergency services

Russell County Hospital

Critical Access Hospitals · Russell Springs, KY
OwnershipGovernment - Local
CMS Certification Number181330
Location153 Dowell RoadRussell Springs, KY 42642 · Russell County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 42503 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$122.77 typical visit price
range $52.76 – $162.27
Typical copayment $30.69 (range $13.19 – $40.56)
Most-billed visit code 99204
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

65.84/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality49.74
Improvement Activities40

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. ROBERT JOHNSON NP
Nurse Practitioner (Adult Health)
104 HARDIN LN STE A
SOMERSET, KY 42503
Pulaski County (606) 678-8323
MATTHEW SHEA DO
Internal Medicine (Nephrology)
104 HARDIN LN STE A
SOMERSET, KY 42503
Pulaski County (606) 678-2063

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Harold Helton's NPI number?

The NPI number for Harold Helton is 1063404481. It was assigned to this individual provider in the NPPES registry on August 22, 2005.

Where is Harold Helton located?

Harold Helton practices at 104 Hardin Ln Ste A, Somerset, KY 42503. The listed phone number is (606) 678-2063.

What is Harold Helton's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Harold Helton enrolled in Medicare?

Yes. Harold Helton is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Harold Helton accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter of Tennessee list Harold Helton as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Harold Helton affiliated with any hospitals?

According to CMS data, Harold Helton is affiliated with Lake Cumberland Regional Hospital, Wayne County Hospital and Russell County Hospital.

When was this NPI record last updated?

The NPPES record for Harold Helton was last updated on June 2, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.