NPIMap

Organization Active NPI

Bluegrass Orthopaedic Group PSC

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Louisville, KY
National Provider Identifier
1043414873
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
Legal business name
BLUEGRASS ORTHOPAEDIC GROUP PSC
Practice address
3920 Dutchmans LN
Suite 314
Louisville, KY 40207-4702
Phone
(502) 895-1489
Fax
(502) 895-1261
NPI assigned
Jun 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Eugene E Jacob, MDNPI 1578587424
Title
President
Phone
(502) 895-1489

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 204C00000X Primary

Addresses

Primary practice location

3920 Dutchmans LN
Suite 314
Louisville, KY 40207-4702

Mailing address

3920 Dutchmans LN
Suite 314
Louisville, KY 40207-4702
Phone (502) 895-1489

National Provider Directory

National Provider Directory

Locations

4402 Churchman Ave
#100
Louisville, KY 40215
Phone (502) 367-6123

3920 Dutchmans Ln
#314
Louisville, KY 40207
Phone (502) 222-0598

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043414873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 DUTCHMANS LN",
            "address_2": "SUITE 314",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074702",
            "telephone_number": "502-895-1489",
            "fax_number": "502-895-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 DUTCHMANS LN",
            "address_2": "SUITE 314",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074702",
            "telephone_number": "502-895-1489",
            "fax_number": "502-895-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS ORTHOPAEDIC GROUP PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-895-1489",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.