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DR. JAMES DALE DUNCAN M.D.
NPI 1598725020
Internal Medicine in Danville, KY

Active since March 27, 2006PECOS EnrolledAccepts Medicare Assignment
478 WHIRLAWAY DR STE 100, DANVILLE, KY 40422(859) 236-6613(859) 236-3558 Get Directions Write a Review

NPPES record last updated: December 15, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 15, 2020, Aug 9, 2019 (2 updates tracked since 2019).

About Dr. James Dale Duncan M.d. NPPES

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

DR. JAMES DALE DUNCAN M.D. (NPI 1598725020) is an individual internal medicine provider in Danville, Kentucky, licensed in Kentucky (35597) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Saint Joseph Hospital, and is a graduate of University Of Kentucky College Of Medicine (1997).

NPPES Registry Identity

NPI1598725020
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. JAMES DALE DUNCANCredential: M.D.
Location Address478 WHIRLAWAY DR STE 100Danville, KY 40422-9037
Mailing AddressPo Box 1080Burkesville, KY 42717-1080 · (270) 858-6655 · Fax (270) 858-4607
Phone(859) 236-6613
Fax(859) 236-3558
Sole ProprietorNo
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1997
Enumeration DateMarch 27, 2006
Last NPPES UpdateDecember 15, 20202 updates tracked since enumeration
NPPES CertifiedDecember 15, 2020
✔ NPI 1598725020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in KY · 35597
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.
478 WHIRLAWAY DR STE 100, Danville, KY 40422
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Other Identifiers 2

Other000000174966KY · Bcbs
Medicaid64010093KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.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

Dr. James Dale Duncan 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 ID6406994268
PECOS Enrollment IDI20091116000356
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

3

Medicare enrollment records show James Duncan reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

James Duncan MD Consulting Service PLLC
0.5 mi
Internal Medicine
109 VENETIAN WAY
Danville, KY 40422
  • Reassigned Medicare billing, Kentucky enrollment
  • 2 clinicians in this Medicare group
NPI 1245830017 (859) 516-6613
Ephraim Mcdowell Regional Medical Center, Incorporated
2.2 mi
Specialist
520 TECHWOOD DR N, STE 100
Danville, KY 40422
  • Reassigned Medicare billing, Kentucky enrollment
  • 75 clinicians in this Medicare group
NPI 1336580554 (859) 236-2203
Kentuckyone Health Medical Group, Inc.
30 mi
Family Medicine
1401 HARRODSBURG RD
Lexington, KY 40504
  • Reassigned Medicare billing, Kentucky enrollment
  • 250 clinicians in this Medicare group
NPI 1104875970 (606) 330-7835

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 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.

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.
166 services79 patients
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
142 services81 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
107 services76 patients
Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306
An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
72 services71 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
43 services40 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
41 services41 patients

Hospital Affiliations CMS Care Compare 3

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

Saint Joseph Hospital

Acute Care Hospitals · Lexington, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number180010
LocationOne Saint Joseph DriveLexington, KY 40504 · Fayette County
Emergency services

Ephraim Mcdowell Regional Medical Center

Acute Care Hospitals · Danville, KY
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180048
Location217 South Third StreetDanville, KY 40422 · Boyle County
Emergency services Birthing friendly

Saint Joseph East

Acute Care Hospitals · Lexington, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180143
Location150 North Eagle Creek DriveLexington, KY 40509 · Fayette County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40422 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.

Referred Medical Equipment & Supplies CMS DME claims 8

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

Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each A4424
DME-Orthotic Devices · category DF010N
1 supplier12 claims360 services$4.21 avg. paid by Medicare
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing A6212
DME-Medical/Surgical Supplies · category DA023N
3 suppliers11 claims143 services$8.88 avg. paid by Medicare
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
2 suppliers40 claims40 services$61.56 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
2 suppliers19 claims19 services$19.12 avg. paid by Medicare
Continuous positive airway pressure (cpap) device E0601
DME-Other DME · category DE001N
1 supplier12 claims12 services$46.22 avg. paid by Medicare
Transport chair, adult size, patient weight capacity up to and including 300 pounds E1038
DME-Other DME · category DE000N
1 supplier19 claims19 services$9.04 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 3

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

JESSICA M CORNELIUS PAC
Physician Assistant
478 WHIRLAWAY DR STE 100
DANVILLE, KY 40422
Boyle County (859) 236-6613
DR. JOHN MICHAEL HORN M.D
Internal Medicine
478 WHIRLAWAY DR STE 100
DANVILLE, KY 40422
Boyle County (859) 236-6613
HEATHER B. SMITH APRN
Nurse Practitioner (Family)
478 WHIRLAWAY DR STE 100
DANVILLE, KY 40422
Boyle County (859) 236-6613

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 Duncan's NPI number?

The NPI number for James Duncan is 1598725020. It was assigned to this individual provider in the NPPES registry on March 27, 2006.

Where is James Duncan located?

James Duncan practices at 478 Whirlaway Dr Ste 100, Danville, KY 40422. The listed phone number is (859) 236-6613.

What is James Duncan's specialty?

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

Is James Duncan enrolled in Medicare?

Yes. James Duncan 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 Duncan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), James Duncan reassigns Medicare benefits to 3 organizations: James Duncan MD Consulting Service PLLC (Danville, KY), Ephraim Mcdowell Regional Medical Center, Incorporated (Danville, KY) and Kentuckyone Health Medical Group, Inc. (Lexington, KY). 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 Duncan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does James Duncan accept?

Health plans from Anthem Blue Cross and Blue Shield list James Duncan 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 James Duncan affiliated with any hospitals?

According to CMS data, James Duncan is affiliated with Saint Joseph Hospital, Ephraim Mcdowell Regional Medical Center and Saint Joseph East.

When was this NPI record last updated?

The NPPES record for James Duncan was last updated on December 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.