ADVANCED INTERNAL MEDICINE PLLC
NPI 1336563543
Internal Medicine in Paducah, KY

Q: What is Advanced Internal Medicine PLLC's NPI number?

The NPI number for Advanced Internal Medicine PLLC is 1336563543. It was assigned to this organization in the NPPES registry on February 7, 2014.

Q: What is Advanced Internal Medicine PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since February 07, 2014CLIA 18D2080497 · Waiver

2005 BROADWAY ST, PADUCAH, KY 42001(270) 366-7650(270) 443-0660 Get Directions Write a Review

NPPES record last updated: December 29, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Advanced Internal Medicine Pllc NPPES

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

ADVANCED INTERNAL MEDICINE PLLC (NPI 1336563543) is a healthcare organization registered as an internal medicine in Paducah, Kentucky and active in the NPI registry since February 2014. The organization holds a CLIA Waiver certificate valid through July 8, 2028, maintains a secondary practice location in Paducah, and lists Ryan Curtis Frazine, Sole Member, as its authorized official.

NPPES Registry Identity

NPI1336563543

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameADVANCED INTERNAL MEDICINE PLLC

Location Address2005 BROADWAY STPaducah, KY 42001-7107

Mailing Address2005 Broadway StPaducah, KY 42001-7107 · (270) 366-7650 · Fax (270) 443-0600

Phone(270) 366-7650

Fax(270) 443-0660

Organization SubpartNo

Authorized OfficialRyan Curtis FrazineSole Member · (270) 994-2625

Enumeration DateFebruary 7, 2014

Last NPPES UpdateDecember 29, 2022

NPPES CertifiedDecember 29, 2022

✔ NPI 1336563543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X

2005 BROADWAY ST, Paducah, KY 42001

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Secondary Practice Location 1

Location 12005 Broadway StPaducah, KY 42001-7107 · Phone (270) 366-7650 · Fax (270) 443-0600

Group Practice 2

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

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Advanced Internal Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateKentuckyEnrollment IDO20140507000318Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Advanced Internal Medicine PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Ryan Frazine, M.D.

Internal Medicine

NPI 1548339070

2005 BROADWAY ST
Paducah, KY 42001

(270) 366-7650

✔ PECOS✔ Accepts MedicareSame address

Dalton Henderson, APRN

Nurse Practitioner

NPI 1841914439

2005 BROADWAY ST
Paducah, KY 42001

(270) 366-7650

✔ PECOS✔ Accepts MedicareSame address

Isaac Mittendorf, MD

Family Practice

NPI 1528595352

2331 NEW HOLT RD
Paducah, KY 42001

(270) 441-4777

✔ PECOS✔ Accepts Medicare4.2 mi

Jennifer Johnson, APRN

Nurse Practitioner

NPI 1821311143

909 S MAIN ST
Marion, KY 42064

(270) 704-4131

✔ PECOS✔ Accepts Medicare34 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 18D2080497

Advanced Internal Medicine, PLLC · Paducah, KY

Active · expires Jul 8, 2028

CLIA Number18D2080497

Laboratory TypePhysician Office

Certificate Effective DateJuly 9, 2026

Certificate Expiration DateJuly 8, 2028

Laboratory DirectorDr. Ryan C. Frazine

Laboratory Phone(270) 366-7650

Laboratory LocationAdvanced Internal Medicine, PLLC2005 Broadway Street, Paducah, KY 42001

CLIA data matches this NPI record on: Address Name Phone

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

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 Advanced Internal Medicine PLLC's NPI number?

The NPI number for Advanced Internal Medicine PLLC is 1336563543. It was assigned to this organization in the NPPES registry on February 7, 2014.

Where is Advanced Internal Medicine PLLC located?

Advanced Internal Medicine PLLC is located at 2005 Broadway St, Paducah, KY 42001. The listed phone number is (270) 366-7650.

What is Advanced Internal Medicine PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Advanced Internal Medicine PLLC enrolled in Medicare?

Yes. Advanced Internal Medicine PLLC is registered in the Medicare PECOS enrollment system.

When is Advanced Internal Medicine PLLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Kentucky, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Advanced Internal Medicine PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Advanced Internal Medicine PLLC, in Family Practice, Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Internal Medicine PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2080497) is associated with this NPI, valid through July 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Advanced Internal Medicine PLLC accept?

Health plans from Anthem Blue Cross and Blue Shield, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Advanced Internal Medicine PLLC 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.

When was this NPI record last updated?

The NPPES record for Advanced Internal Medicine PLLC was last updated on December 29, 2022. 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.