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DR. TOM OAK MCGUIRE JR. M.D.
NPI 1205812435
Obstetrics & Gynecology in Pikeville, KY

Active since December 20, 2005PECOS EnrolledAccepts Medicare Assignment
86.86/100
CMS Quality Rating
911 BYPASS RD BLDG A, PIKEVILLE, KY 41501(606) 430-2207(606) 218-7507 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2023, Jul 8, 2022, Apr 20, 2021 and 1 more (4 updates tracked since 2016).

About Dr. Tom Oak Mcguire Jr. M.d. NPPES

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

DR. TOM OAK MCGUIRE JR. M.D. (NPI 1205812435) is an individual obstetrics & gynecology provider in Pikeville, Kentucky, licensed in Kentucky (20022) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS, is affiliated with Pikeville Medical Center, and is a graduate of University Of Kentucky College Of Medicine (1973).

NPPES Registry Identity

NPI1205812435
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameDR. TOM OAK MCGUIRE JR.Credential: M.D.
Location Address911 BYPASS RD BLDG APikeville, KY 41501-1689
Mailing AddressPo Box 432Pikeville, KY 41502-0432 · (606) 430-2207 · Fax (606) 218-7507
Phone(606) 430-2207
Fax(606) 218-7507
Sole ProprietorNo
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1973
Enumeration DateDecember 20, 2005
Last NPPES UpdateMarch 7, 20234 updates tracked since enumeration
NPPES CertifiedJuly 8, 2022
✔ NPI 1205812435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in KY · 20022
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
911 BYPASS RD BLDG A, Pikeville, KY 41501
Open in Google Maps ↗

Other Identifiers 2

Other20022KY · Medical License Number
Medicaid64200223KY

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. Tom Oak Mcguire 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 ID7214105337
PECOS Enrollment IDI20110901000456
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

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.

Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101
This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.
14 services14 patients

Hospital Affiliations CMS Care Compare

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

Pikeville Medical Center

Acute Care Hospitals · Pikeville, KY
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180044
Location911 Bypass RoadPikeville, KY 41501 · Pike County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41501 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
$66.24 typical visit price
range $16.53 – $131.99
Typical copayment $16.56 (range $4.13 – $32.99)
Most-billed visit code 99213
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.

86.86/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality72.39
Promoting Interoperability100
Improvement Activities40
Cost70.65

Other Providers at the Same Location NPPES 20

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

MRS. WHITNEY P. BURTON PA-C
Physician Assistant
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-2201
DR. SHRAVANTI PONGALI MUTHU MD, MPH
Internal Medicine
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-3500
AMY O JOHNSON MD
Surgery
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-2205
MATTHEW SEXTON M.D.
Anesthesiology (Critical Care Medicine)
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-3500
CAITLIN VICTORIA BERNIECE COLLIER
Nurse Practitioner (Family)
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-2208
BRIANNA I COLEMAN
Nurse Practitioner (Family)
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-2201
EMUESIRI CATHERINE OVWIGHO MD
Hospitalist
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-3500
TRULENA BENNER CRNA
Nurse Anesthetist, Certified Registered
911 BYPASS RD BLDG A
PIKEVILLE, KY 41501
Pike County (606) 430-3500

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 Tom Mcguire's NPI number?

The NPI number for Tom Mcguire is 1205812435. It was assigned to this individual provider in the NPPES registry on December 20, 2005.

Where is Tom Mcguire located?

Tom Mcguire practices at 911 Bypass Rd Bldg A, Pikeville, KY 41501. The listed phone number is (606) 430-2207.

What is Tom Mcguire's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Tom Mcguire enrolled in Medicare?

Yes. Tom Mcguire 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 Tom Mcguire accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter of Tennessee and CareSource list Tom Mcguire 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 Tom Mcguire affiliated with any hospitals?

According to CMS data, Tom Mcguire is affiliated with Pikeville Medical Center.

When was this NPI record last updated?

The NPPES record for Tom Mcguire was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.