NPIMap

Individual provider Active NPI

Rebecca Ervin Davis

  • Family Medicine Physician
  • Louisville, KY
National Provider Identifier
1063806099
Registry record updated Feb 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R3749 Issued in KY
Practice address
201 Abraham Flexner Way
Suite 690
Louisville, KY 40202-3841
Phone
(502) 852-0132
NPI assigned
Mar 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X R3749 KY Primary

Addresses

Primary practice location

201 Abraham Flexner Way
Suite 690
Louisville, KY 40202-3841

Mailing address

201 Abraham Flexner Way
Suite 690
Louisville, KY 40202-3841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, CO2 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
I20170207003124 KY Practitioner - Family Practice 6901189414 Reassigns benefits to 1 organization
I20181010002579 CO Practitioner - Family Practice 6901189414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12169 Sheridan Blvd
Broomfield, CO 80020-2459
Phone (303) 603-9400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R3749KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Family Medicine CurrentSince Oct 29, 2018 Accepting new patients
Intermountain Medical Group Denver, LLC Family Medicine Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2017 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Oct 29, 2018 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2017 Accepting new patients

Locations

12169 Sheridan Blvd
Broomfield, CO 80020
Phone (303) 439-0169

500 Eldorado Blvd
Ste 6300
Broomfield, CO 80021
Phone (303) 272-0803

1400 Jackson St
Bldg 550
Denver, CO 80206

1400 Jackson St
Bldg T
Denver, CO 80206
Phone (303) 812-3800

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1063806099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 ABRAHAM FLEXNER WAY",
            "address_2": "SUITE 690",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ABRAHAM FLEXNER WAY",
            "address_2": "SUITE 690",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023841",
            "telephone_number": "502-852-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "REBECCA",
        "middle_name": "ERVIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "R3749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.