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JAMES DEREK SWORD DO
NPI 1356751929
Family Medicine in Pikeville, KY

Active since May 05, 2014PECOS EnrolledAccepts Medicare Assignment
80.89/100
CMS Quality Rating
911 BYPASS ROAD, PIKEVILLE MEDICAL CENTER RESIDENCY PROGRAM, PIKEVILLE, KY 41501(606) 218-3985(606) 218-4620 Get Directions Write a Review

NPPES record last updated: September 23, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About James Derek Sword Do NPPES

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

JAMES DEREK SWORD DO (NPI 1356751929) is an individual family medicine provider in Pikeville, Kentucky, licensed in Kentucky (04006) and active in the NPI registry since May 2014. He is enrolled in Medicare PECOS, maintains a secondary practice location in Lexington, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1356751929
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJAMES DEREK SWORDCredential: DO
Location Address911 BYPASS ROAD, PIKEVILLE MEDICAL CENTER RESIDENCY PROGRAMPikeville, KY 41501
Mailing Address911 Bypass Road, Pikeville Medical Center Residency ProgramPikeville, KY 41501 · (606) 218-3985 · Fax (606) 218-4620
Phone(606) 218-3985
Fax(606) 218-4620
Sole ProprietorNo
Medical School CMSOtherGraduated 2014
Enumeration DateMay 5, 2014
Last NPPES UpdateSeptember 23, 2025
NPPES CertifiedSeptember 23, 2025
✔ NPI 1356751929 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in KY · 04006
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
911 BYPASS ROAD, Pikeville, KY 41501
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Secondary Practice Location 1

Location 11221 S BroadwayLexington, KY 40504-2701 · Phone (859) 258-4000

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

James Derek Sword Do 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 ID7517251689
PECOS Enrollment IDI20160811002810
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.

Medicare Billing Reassignments

9

Medicare enrollment records show James Sword reassigns Medicare billing to 9 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Beaver Creek Emergency Group LLC
15 mi
Emergency Medicine
11203 MAIN ST
Martin, KY 41649
  • Reassigned Medicare billing, Kentucky enrollment
  • 26 clinicians in this Medicare group
NPI 1689165904 (606) 285-6490
Southern Medical Partners, LLC
39 mi
Emergency Medicine
100 MEDICAL CENTER DRIVE
Hazard, KY 41701
  • Reassigned Medicare billing, Kentucky enrollment
  • 153 clinicians in this Medicare group
NPI 1538109962 (606) 439-6651
Hyden Emergency Physicians, LLC
52 mi
Emergency Medicine
130 KATE IRELAND DR
Hyden, KY 41749
  • Reassigned Medicare billing, Kentucky enrollment
  • 45 clinicians in this Medicare group
NPI 1497036776 (877) 693-5700
Berea Urgent Care LLC
99 mi
Nurse Practitioner
234 BRENWOOD ST
Berea, KY 40403
  • Reassigned Medicare billing, Kentucky enrollment
  • 69 clinicians in this Medicare group
NPI 1912054792 (859) 985-0302
Clark Emergency Physicians
100 mi
Emergency Medicine
175 HOSPITAL DR
Winchester, KY 40391
  • Reassigned Medicare billing, Kentucky enrollment
  • 36 clinicians in this Medicare group
NPI 1346781499 (859) 737-6500
Southeastern Emergency Physicians LLC
107 mi
Emergency Medicine
989 MEDICAL PARK DR
Maysville, KY 41056
  • Reassigned Medicare billing, Kentucky enrollment
  • 828 clinicians in this Medicare group
NPI 1356379382 (606) 759-5311
Lexington Urgent Care PLLC
115 mi
Urgent Care
1701 NICHOLASVILLE RD, STE 100
Lexington, KY 40503
  • Reassigned Medicare billing, Kentucky enrollment
  • 72 clinicians in this Medicare group
NPI 1225374887 (859) 466-8956
Man O War Urgent Care LLC
116 mi
Urgent Care
4097 NICHOLS PARK DR STE 108
Lexington, KY 40503
  • Reassigned Medicare billing, Kentucky enrollment
  • 66 clinicians in this Medicare group
NPI 1083101240 (859) 523-5310
Georgetown Urgent Care PLLC
122 mi
Urgent Care
111 OSBOURNE WAY, SUITE 101
Georgetown, KY 40324
  • Reassigned Medicare billing, Kentucky enrollment
  • 66 clinicians in this Medicare group
NPI 1780838847 (859) 466-8956

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

Areas of Expertise CMS Part B claims 3

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.

Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
64 services61 patients
Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
62 services59 patients
Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
11 services11 patients

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
$82.24 typical visit price
range $52.76 – $162.27
Typical copayment $20.56 (range $13.19 – $40.56)
Most-billed visit code 99203
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.

80.89/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality62.29
Promoting Interoperability100
Improvement Activities40
Cost74

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Nebulizer, with compressor E0570
DME-Other DME · category DE000N
1 supplier28 claims28 services$2.90 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 6

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

MS. CIARA MARY FERGUSON RD,LD
Dietitian, Registered
911 BYPASS ROAD
PIKEVILLE, KY 41501
Pike County (606) 218-3500
MR. MICHAEL A. SCROGGINS CRNA
Nurse Anesthetist, Certified Registered
911 BYPASS ROAD
PIKEVILLE, KY 41501
Pike County (606) 218-3500
DR. WILLIAM SAMUEL LEIGHTON D.O.
Anesthesiology
911 BYPASS ROAD, DEPARTMENT OF ANESTHESIOLOGY
PIKEVILLE, KY 41501
Pike County (606) 218-3500
PIKEVILLE MEDICAL CENTER INC.
Pharmacy (Specialty Pharmacy)
911 BYPASS ROAD, BUILDING E SUITE 2
PIKEVILLE, KY 41501
Pike County (606) 218-3576
GINA DIANA ARNP
Nurse Practitioner (Adult Health)
911 BYPASS ROAD, 5TH FLOOR ELLIOTT BUILDING
PIKEVILLE, KY 41501
Pike County (606) 218-2217
ESTHER LEE GRECO D.O.
Family Medicine
911 BYPASS ROAD, PIKEVILLE MEDICAL CENTER RESIDENCY PROGRAM
PIKEVILLE, KY 41501
Pike County (606) 218-3985

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 James Sword's NPI number?

The NPI number for James Sword is 1356751929. It was assigned to this individual provider in the NPPES registry on May 5, 2014.

Where is James Sword located?

James Sword practices at 911 Bypass Road Pikeville Medical Center Residency Program, Pikeville, KY 41501. The listed phone number is (606) 218-3985.

What is James Sword's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is James Sword enrolled in Medicare?

Yes. James Sword 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.

Which organizations bill Medicare for James Sword's services?

According to the CMS Revalidation Reassignment List (October 2026 release), James Sword reassigns Medicare benefits to 9 organizations: Beaver Creek Emergency Group LLC (Martin, KY), Southern Medical Partners, LLC (Hazard, KY), Hyden Emergency Physicians, LLC (Hyden, KY), Berea Urgent Care LLC (Berea, KY), Clark Emergency Physicians (Winchester, KY) and 4 more organizations, listed in the Medicare section above. Each 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 James Sword's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does James Sword accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter of Tennessee list James Sword 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 James Sword was last updated on September 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.