Organization Active NPI

University Pediatric Endocrinology, LLC

  • Pediatric Endocrinology Physician
  • Bowling Green, KY
National Provider Identifier
1013216936
Registry record updated Mar 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
Legal business name
UNIVERSITY PEDIATRIC ENDOCRINOLOGY, LLC
Practice address
720 2ND St
Ste 102
Bowling Green, KY 42101-1778
Phone
(502) 629-8821
Fax
(502) 629-8824
NPI assigned
Mar 17, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gerard P Rabalais, MD
Title
Chairman
Phone
(502) 852-8600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0205X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X

Addresses

Primary practice location

720 2ND St
Ste 102
Bowling Green, KY 42101-1778

Mailing address

PO Box 2469
Louisville, KY 40201-2469
Phone (502) 852-8500

Other identifiers 2

IdentifierTypeStateIssuer
200889620MedicaidIN
7100010410MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
University Pediatric Endocrinology LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301270400000",
    "number": "1013216936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2469",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402012469",
            "telephone_number": "502-852-8500",
            "fax_number": "502-852-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 2ND ST",
            "address_2": "STE 102",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011778",
            "telephone_number": "502-629-8821",
            "fax_number": "502-629-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PEDIATRIC ENDOCRINOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2011-03-28",
        "status": "A",
        "authorized_official_last_name": "RABALAIS",
        "authorized_official_first_name": "GERARD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "502-852-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200889620",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100010410",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.