Individual provider Active NPI

Carolyn Marie Thomas, R.D.,L.D.

  • Registered Dietitian
  • Louisville, KY
National Provider Identifier
1104004043
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
124752 Issued in KY
Practice address
950 Breckenridge LN Ste 10
Louisville, KY 40207-5931
Phone
(502) 894-9499
Fax
(502) 894-9595
NPI assigned
Feb 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2075 KY
Registered Dietitian 133V00000X 1685 TN
Registered Dietitian 133V00000X 124752 KY Primary

Addresses

Primary practice location

950 Breckenridge LN Ste 10
Louisville, KY 40207-5931

Mailing address

3008 W Highway 42
La Grange, KY 40031-7527
Phone (615) 306-0294

Other names 1

  • Carolyn Boice Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240412002814 KY Practitioner - Registered Dietitian Or Nutrition Professional 3274972005 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
124752KYMDRegistered Dietitian
2075KYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Mar 28, 2024 Accepting new patients
Baptist Medical Associates Inc CurrentSince Mar 28, 2024 Accepting new patients
Nourish, Inc. Dietitian, Registered Past Accepting new patients

Locations

950 Breckenridge Ln
Ste 10
Louisville, KY 40207
Phone (502) 894-9499

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1104004043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 W HIGHWAY 42",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400317527",
            "telephone_number": "615-306-0294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 BRECKENRIDGE LN STE 10",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402075931",
            "telephone_number": "502-894-9499",
            "fax_number": "502-894-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "CAROLYN",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "R.D.,L.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-01",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "KY",
            "license": "2075",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "1685",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "KY",
            "license": "124752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "BOICE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.