PATRIOT ONE PRIMARY CARE PSC - NPI 1114660735 - General Practice in Lexington, KY

Q: What is Patriot One Primary Care Psc's NPI number?

The NPI number for Patriot One Primary Care Psc is 1114660735. It was assigned to this organization in the NPPES registry on April 20, 2022.

Q: What is Patriot One Primary Care Psc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

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About Patriot One Primary Care Psc NPPES

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

PATRIOT ONE PRIMARY CARE PSC (NPI 1114660735) is a healthcare organization registered as a general practice in Lexington, Kentucky and active in the NPI registry since April 2022. The organization holds a CLIA Waiver certificate valid through October 11, 2026 and lists Janine Lippert, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1114660735

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NamePATRIOT ONE PRIMARY CARE PSC

Location Address989 GOVERNORS LN STE 140Lexington, KY 40513-1174

Mailing Address989 Governors Ln Ste 220Lexington, KY 40513-1175 · (859) 447-8014

Phone(859) 447-8014

Organization SubpartNo

Authorized OfficialJanine LippertNurse Practitioner · (859) 433-4661

Enumeration DateApril 20, 2022

Last NPPES UpdateAugust 2, 20222 updates tracked since enumeration

NPPES CertifiedAugust 2, 2022

✔ NPI 1114660735 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

989 GOVERNORS LN STE 140, Lexington, KY 40513

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Other Identifiers 1

Medicaid7100137000KY

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D2270238

Patriot One Primary Care · Lexington, KY

Active · expires Oct 11, 2026

CLIA Number18D2270238

Laboratory TypePhysician Office

Certificate Effective DateOctober 12, 2024

Certificate Expiration DateOctober 11, 2026

Laboratory DirectorMs. Elizabeth K. Mentzer

Laboratory Phone(859) 447-8014

Laboratory LocationPatriot One Primary Care989 Governors Ln Ste 220, Lexington, KY 40513

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

JONATHAN TODD RYSER-OATMAN PH.D.

Psychologist