NPIMap

Individual provider Active NPI

Keith Wellington Myrick, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Louisville, KY
National Provider Identifier
1063402972
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
251 Issued in KY
Practice address
6400 Dutchmans Pkwy
Suite 215
Louisville, KY 40205-3340
Phone
(502) 721-8288
Fax
(502) 721-8792
NPI assigned
Oct 24, 2005
Last updated
Aug 30, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 251 KY Primary

Addresses

Primary practice location

6400 Dutchmans Pkwy
Suite 215
Louisville, KY 40205-3340

Mailing address

6400 Dutchmans Pkwy
Suite 215
Louisville, KY 40205-3340
Phone (502) 721-8288

Other identifiers 4

IdentifierTypeStateIssuer
201363620MedicaidIN
80000318MedicaidKY
50007597OtherKYPASSPORT
0000000382017OtherKYBLUE PREFERRED (ANTHEM)

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
I20050112000077 KY Practitioner - PodiatryPractitioner - Orthopedic SurgeryPractitioner - Peripheral Vascular Disease 6709834120 Reassigns benefits to 1 organization
I20130419000330 IN Practitioner - PodiatryPractitioner - Orthopedic SurgeryPractitioner - Peripheral Vascular Disease 6709834120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
PodiatryAlso: Orthopedic Surgery, Peripheral Vascular Disease
Education
Kent State University College of Podiatric Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

200 Missouri Ave
Suite a
Jeffersonville, IN 47130-3014
Phone (812) 920-0055

210 E Gray St
Suite 820
Louisville, KY 40202-3900
Phone (502) 585-3668

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue16
Removal of skin lesions1-10
Removal of nail tissue29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
251KYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Tipton & Unroe, PSC Foot & Ankle Surgery Past Accepting new patients
Kentuckiana Foot & Ankle, PLLC Foot & Ankle Surgery Past Accepting new patients
Sports Medicine Surgical Specialists PLLC Past Accepting new patients

Organizations & group practices 5

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1063402972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY",
            "address_2": "SUITE 215",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053340",
            "telephone_number": "502-721-8288",
            "fax_number": "502-721-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY",
            "address_2": "SUITE 215",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053340",
            "telephone_number": "502-721-8288",
            "fax_number": "502-721-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYRICK",
        "first_name": "KEITH",
        "middle_name": "WELLINGTON",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KY",
            "license": "251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201363620",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80000318",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50007597",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PREFERRED (ANTHEM)",
            "identifier": "0000000382017",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.