Pearl Medical Practice PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PEARL MEDICAL PRACTICE PLLC

Practice address

4200 Gardiner View Ave
Suite 200
Louisville, KY 40213-1877

Phone

(502) 456-0494

Fax

(502) 456-0496

NPI assigned

Nov 15, 2012

Last updated

Oct 2, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Osawaru Omoruyi, M.D.NPI 1396961967

Title

President

Phone

(502) 456-0494

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY, IN, FL, OH4 enrollments

Enrollment records 4

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Osawaru Jude Omoruyi, M.D

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1396961967

  FL, IN, OH

  Medicare reassignment Care Compare group Authorized official
• Mark Todd Harris, APRN

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1538542816
  Medicare reassignment Care Compare group NPD
• Ailyn Arias Quijano, NP

  • Family Nurse Practitioner
  • Land O' Lakes, FL
  • NPI 1003652405

  KY

  Medicare reassignment NPD
• Nina Jankoski, APRN, AGACNP

  • Gerontology Nurse Practitioner
  • Louisville, KY
  • NPI 1982342879
  NPD
• Alla Lisova, APRN

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1285299313
  NPD
• Constance M Lyons, APRN

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1770951014
  NPD
• Liudmila Padron Rodriguez Mena, NP

  • Gerontology Nurse Practitioner
  • Louisville, KY
  • NPI 1942898333

  Single Specialty

  NPD
• Lindsey Thomas, APRN

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1417601451
  NPD
• Angela Washington

  • Acute Care Nurse Practitioner
  • Lexington, KY
  • NPI 1790497659
  NPD
• Jennifer L. Cote, APN, FNP

  • Nurse Practitioner
  • Lake Forest, IL
  • NPI 1609235381

  Family

  NPD

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443744000000",
    "number": "1114261203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 GARDINER VIEW AVE",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131877",
            "telephone_number": "502-456-0494",
            "fax_number": "502-456-0496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 GARDINER VIEW AVE",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131877",
            "telephone_number": "502-456-0494",
            "fax_number": "502-456-0496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL MEDICAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2015-10-02",
        "status": "A",
        "authorized_official_last_name": "OMORUYI",
        "authorized_official_first_name": "OSAWARU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-456-0494",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100259660",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100267920",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vincent J Peak, PHARMD
• Isaac Andrew Pearce, DO
• Justin Paul Pearce, CRNA
• Pearl Diagnostic Laboratory, LLC
• Pearl Geriatrics and Palliative Medicine, PSC
• Pearl Medical Practice PLLC
• Pearl Medical Practice PLLC (New Dawn Recovery Services)
• Carol Jane Pearl, PTA
• Peter Pearlman, MS-FAAA
• Pearls of Grace, Inc.

• Primary Care Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Primary Care Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; 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.