| Northgate Medical Group | |
|
106 Commercial Dr Harrodsburg KY 40330-1084 | |
| (859) 734-3482 | |
| (859) 734-3432 |
| Full Name | Northgate Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 106 Commercial Dr, Harrodsburg, Kentucky |
| Authorized Official Name and Position | Richard M Dartt (M.D) |
| Authorized Official Contact | 8597343482 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northgate Medical Group 106 Commercial Dr Harrodsburg KY 40330-1084 Ph: (859) 734-3482 | Northgate Medical Group 106 Commercial Dr Harrodsburg KY 40330-1084 Ph: (859) 734-3482 |
| NPI Number | 1063691590 |
|---|---|
| Provider Enumeration Date | 11/01/2007 |
| Last Update Date | 05/01/2012 |
| Medicare PECOS PAC ID | 4880629179 |
|---|---|
| Medicare Enrollment ID | O20051005000967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063691590 | NPI | - | NPPES |
| 65933699 | Medicaid | KY | |
| CJ7187 | Other | RAILROAD MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34877 (Kentucky) | Primary |
| 363A00000X | Physician Assistant | PA979 (Kentucky) | Secondary |
| 363L00000X | Nurse Practitioner | 3002678 (Kentucky) | Secondary |
| Provider Name | Richard Myron Dartt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013969849 PECOS PAC ID: 5698738557 Enrollment ID: I20041111000057 |
| Provider Name | Virginia M Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124084538 PECOS PAC ID: 9638190481 Enrollment ID: I20051208000660 |
| Provider Name | Stephen Kirk Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255419776 PECOS PAC ID: 1052670031 Enrollment ID: I20180119001969 |
| Provider Name | Makenzie Record |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255060554 PECOS PAC ID: 3375910649 Enrollment ID: I20221031001975 |
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