NPIMap

Individual provider Active NPI

Jackson George Unteriner, MD

  • Diagnostic Radiology Physician
  • Louisville, KY
National Provider Identifier
1053874776
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
60448 Issued in KY
Practice address
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone
(502) 447-8786
Fax
(502) 447-8786
NPI assigned
Apr 9, 2019
Last updated
Sep 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2020011736 MO
Diagnostic Radiology Physician 2085R0202X 60448 KY Primary
Vascular & Interventional Radiology Physician 2085R0204X 60448 KY

Addresses

Primary practice location

1 Audubon Plaza Dr
Louisville, KY 40217-1318

Mailing address

9152 Taylorsville Rd # 276
Louisville, KY 40299-1752
Phone (502) 447-8786

Other practice location 1

9152 Taylorsville Rd # 276
Louisville, KY 40299-1752
Phone (502) 447-8786

Other identifiers 2

IdentifierTypeStateIssuer
300110382MedicaidIN
7101050170MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250409000387 KY Practitioner - Diagnostic Radiology 6002141991 Reassigns benefits to 1 organization
I20250410001438 IN Practitioner - Diagnostic Radiology 6002141991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Wisconsin, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic X-Ray Physicians, PSCGroup PAC ID 1355239534, 36 clinicians

Practice addresses (Care Compare)

1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone (502) 636-7111

1451 N Gardner St
Scottsburg, IN 47170-7751
Phone (502) 447-8786

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2020011736MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic X-Ray Physicians, PSC Diagnostic Radiology CurrentSince Apr 28, 2025 Accepting new patients

Locations

2021 Mercy Way
Ste 102
Jeffersonville, IN 47130
Phone (812) 218-4630

1220 Missouri Ave
Jeffersonvlle, IN 47130
Phone (812) 282-2072

1451 N Gardner St
Scottsburg, IN 47170
Phone (812) 752-8500

130 Hunter Station Way
Sellersburg, IN 47172
Phone (812) 246-4808

157 Towne Dr
Ste 101
Elizabethtown, KY 42701
Phone (270) 740-5201

1 Audubon Plaza Dr
Louisville, KY 40217
Phone (502) 634-6767

3991 Dutchmans Ln
Ste 208
Louisville, KY 40207
Phone (502) 897-2440

850 S 28th St
Louisville, KY 40211
Phone (502) 629-7650

9152 Taylorsville Rd
Louisville, KY 40299
Phone (502) 424-5635

9344 Cedar Center Way
Louisville, KY 40291
Phone (502) 753-3390

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1053874776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9152 TAYLORSVILLE RD # 276",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402991752",
            "telephone_number": "502-447-8786",
            "fax_number": "502-447-8623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171318",
            "telephone_number": "502-447-8786",
            "fax_number": "502-447-8786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9152 Taylorsville Rd # 276",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402991752",
            "country_code": "US",
            "telephone_number": "502-447-8786",
            "fax_number": "502-447-8623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UNTERINER",
        "first_name": "JACKSON",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-09",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2020011736",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "60448",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "KY",
            "license": "60448",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300110382",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101050170",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.