Individual provider Active NPI

Alma Ljaljevic-Tucakovic, D.M.D.

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1033108865
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7858 Issued in KY
Practice address
401 E. Chestnut St.
Ste. 550
Louisville, KY 40202
Phone
(502) 852-5401
Fax
(502) 852-7602
NPI assigned
Oct 14, 2005
Last updated
Mar 18, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7858 KY Primary

Addresses

Primary practice location

401 E. Chestnut St.
Ste. 550
Louisville, KY 40202

Mailing address

501 S. Preston St.
RM 122
Louisville, KY 40292
Phone (502) 852-5103

Other identifiers 2

IdentifierTypeStateIssuer
60001617MedicaidKY
15873MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160906000049 KY Order and Referring Only - DentistPractitioner - Dentist 2668596073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7858KYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237334400000",
    "number": "1033108865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S. PRESTON ST.",
            "address_2": "RM 122",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40292",
            "telephone_number": "502-852-5103",
            "fax_number": "502-852-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E. CHESTNUT ST.",
            "address_2": "STE. 550",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40202",
            "telephone_number": "502-852-5401",
            "fax_number": "502-852-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LJALJEVIC-TUCAKOVIC",
        "first_name": "ALMA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2009-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "7858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60001617",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15873",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.