Elite Internal Medicine
Organization Active NPI Internal Medicine Physician · Prospect, KY
NPI 1033597828 · NPPES record last updated May 6, 2022
Key facts
- NPI
- 1033597828
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- ELITE INTERNAL MEDICINE
- Practice address
- 9537 US Highway 42
Prospect, KY 40059-9301 - Phone
- (502) 713-1332
- Fax
- (502) 713-1218
- NPI assigned
- May 12, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Tina Yuan, MD
- Title
- Owner
- Phone
- (502) 713-1332
Practitioners 4
-
Tina T Yuan, M.D.
-
Allyson Riggs, DNP, FNP-C
-
Katherine Paige Thompson, MSN, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2098061 | Elite Internal Medicine | Certificate of waiver | Mar 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150722003726 | KY | Part B Supplier - Clinic/Group Practice | 7810200730 |
Receives reassigned benefits from 4 practitioners Practice locations: Louisville, KY |
National Provider Directory
Locations
10501 Fischer Park Dr
Louisville, KY 40241
Phone (502) 713-1218
9537 US Highway 42
Prospect, KY 40059
Phone (502) 713-1332
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
9537 US Highway 42
Prospect, KY 40059-9301
Mailing address
PO Box 319
Prospect, KY 40059-0319
Phone (502) 713-1332
Other practice location 1
10501 Fischer Park Dr
Louisville, KY 40241-4139
Phone (502) 713-1218
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50091760 | Other | KY | PASSPORT HEALTH PLAN |
Other names
- Prospect Internal Medicine
Other providers in Prospect, KY
- Megan Christine Durbin
- Jennifer Helen Dutton
- Efillrx, LLC
- Egan Clinic PSC
- Sheirin Elabsy
- Sarah Embry
- Jaclyn Engelsher
- Exceptional Senior Living-Prospect, LLC
- Genevieve Page First
- Hannah Nicole Floyd
All providers in Prospect, KY · Internal Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.