NPIMap

Individual provider Active NPI

Miriam Mercado Reyes, MD

  • Family Medicine Physician
  • Louisville, KY
National Provider Identifier
1063412724
Registry record updated Mar 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36075 Issued in KY
Practice address
3425 Stony Spring Cir
Louisville, KY 40220-5437
Phone
(502) 367-3100
Fax
(502) 491-6619
NPI assigned
Jul 26, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36075 KY Primary

Addresses

Primary practice location

3425 Stony Spring Cir
Louisville, KY 40220-5437

Mailing address

3425 Stony Spring Cir
Louisville, KY 40220-5437
Phone (502) 367-3100

Other identifiers 1

IdentifierTypeStateIssuer
64017189MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060703000017 KY Practitioner - Family Practice 8022020353 Practice locations: Louisville, KY

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3425 Stony Spring Cir
Louisville, KY 40220-5437
Phone (502) 367-3100

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: miriam.reyes@221603719938052.direct.elationemr.com

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267747200000",
    "number": "1063412724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 STONY SPRING CIR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402205437",
            "telephone_number": "502-367-3100",
            "fax_number": "502-491-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 STONY SPRING CIR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402205437",
            "telephone_number": "502-367-3100",
            "fax_number": "502-491-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES",
        "first_name": "MIRIAM",
        "middle_name": "MERCADO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2010-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "36075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64017189",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.