Active NPI
Premier ENT and Allergy, PLLC
- Otolaryngology Physician
- Louisville, KY
National Provider Identifier
1083731277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 28995
- Legal business name
- PREMIER ENT AND ALLERGY, PLLC
- Practice address
- 2429 Bush Ridge Dr Ste 103
Louisville, KY 40245-5914 - Phone
- (502) 893-3683
- NPI assigned
- Mar 23, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Carl David Coppola, MD
- Title
- Owner
- Phone
- (502) 893-3683
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 28995 | KY | Primary |
Addresses
Primary practice location
2429 Bush Ridge Dr Ste 103
Louisville, KY 40245-5914
Mailing address
2429 Bush Ridge Dr Ste 103
Louisville, KY 40245-5914
Phone (502) 893-3683
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000045669 | Other | KY | BCBS |
| CB0478 | Other | KY | RR MEDICARE |
| 1052620 | Other | KY | PASSPORT |
| 64289952 | Medicaid | KY |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1578614400000",
"number": "1083731277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2429 BUSH RIDGE DR STE 103",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402455914",
"telephone_number": "502-893-3683",
"fax_number": "502-893-1662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2429 BUSH RIDGE DR STE 103",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402455914",
"telephone_number": "502-893-3683"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER ENT AND ALLERGY, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-23",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A",
"authorized_official_last_name": "COPPOLA",
"authorized_official_first_name": "CARL",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "502-893-3683",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": "KY",
"license": "28995",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000045669",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CB0478",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "1052620",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64289952",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.