NPIMap

Individual provider Active NPI

Jeffrey M. Stidam, MD

  • Clinical Cardiac Electrophysiology Physician
  • Louisville, KY
National Provider Identifier
1063545275
Registry record updated Mar 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
39017 Issued in KY
Practice address
225 Abraham Flexner Way
Suite 305
Louisville, KY 40202-1882
Phone
(502) 585-4321
Fax
(502) 566-6338
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 01063360A IN
Cardiovascular Disease Physician 207RC0000X 39017 KY
Clinical Cardiac Electrophysiology Physician 207RC0001X 01063360A IN
Clinical Cardiac Electrophysiology Physician 207RC0001X 39017 KY Primary

Addresses

Primary practice location

225 Abraham Flexner Way
Suite 305
Louisville, KY 40202-1882

Mailing address

100 E Liberty St Ste 800
Louisville, KY 40202-1428
Phone (502) 585-4321

Other identifiers 2

IdentifierTypeStateIssuer
200856500MedicaidIN
7100069260MedicaidKY

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
I20081010000015 KY Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0648377895 Reassigns benefits to 1 organization
I20100513001012 IN Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 0648377895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine
Education
University of Louisville School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Louisville Physicians IncGroup PAC ID 3476725599, shared by 5 NPIs, 1,438 clinicians

Practice addresses (Care Compare)

201 Abraham Flexner Way
Suite 1200
Louisville, KY 40202-3481
Phone (502) 583-8383

213 Hunter Station Rd
Sellersburg, IN 47172-1879
Phone (812) 248-2560

Hospital & facility affiliations

  • Vna Health at Home Home health agency, Louisville, KY, CCN 187000
  • UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Hospital, Louisville, KY, CCN 180040
  • Frankfort Regional Medical Center Hospital, Frankfort, KY, CCN 180127
  • University of Louisville Hospital Hospital, Louisville, KY, CCN 180141
  • Uofl Health - Shelbyville Hospital Hospital, Shelbyville, KY, CCN 180016
  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair68

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01063360AINMDClinical Cardiac Electrophysiology Physician
39017KYMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Nov 1, 2019 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Nov 1, 2019 Accepting new patients
University of Louisville Physicians, Inc Current Accepting new patients
University of Louisville Physicians, Inc. Cardiovascular Disease CurrentSince Jul 1, 2020 Accepting new patients
Norton Enterprises, Inc. Past Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients
Uofl Health-Louisville Inc PastSince Feb 26, 2020 Accepting new patients
Uofl Health-Louisville Inc Past Accepting new patients
University of Louisville Physicians, Inc. Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

213 Hunter Station Rd
Sellersburg, IN 47172
Phone (812) 248-2560

225 Abraham Flexner Way
Ste 305
Louisville, KY 40202
Phone (800) 553-1799

3920 Dutchmans Ln
Ste 316
Louisville, KY 40207
Phone (502) 899-1213

200 Abraham Flexner Way
Louisville, KY 40202
Phone (502) 569-7983

201 Abraham Flexner Way
Ste 1200
Louisville, KY 40202
Phone (502) 583-8383

5100 Outer Loop
Louisville, KY 40219
Phone (502) 968-6226

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Interoperability endpoints

  • Direct secure messaging: jstidam14037@uoflhealth-dm.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Frazier Rehab InstituteLouisville, KY, CCN 18T040 Hospital Corporate Director Feb 26, 2020
Uofl Health-Louisville IncLouisville, KY, CCN 18S040 Hospital Corporate Director Feb 26, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1063545275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST STE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021428",
            "telephone_number": "502-585-4321",
            "fax_number": "502-566-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 ABRAHAM FLEXNER WAY",
            "address_2": "SUITE 305",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021882",
            "telephone_number": "502-585-4321",
            "fax_number": "502-566-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDAM",
        "first_name": "JEFFREY",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01063360A",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "KY",
            "license": "39017",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IN",
            "license": "01063360A",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "KY",
            "license": "39017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200856500",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100069260",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.