NPIMap

Individual provider Active NPI

Amanda L Denzik, DPM

  • Foot & Ankle Surgery Podiatrist
  • Louisville, KY
National Provider Identifier
1124316195
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
243983 Issued in KY
Practice address
4612 Outer Loop
Louisville, KY 40219-3971
Phone
(502) 968-2233
Fax
(502) 968-2283
NPI assigned
Jul 12, 2011
Last updated
Jul 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 07001180A IN
Foot & Ankle Surgery Podiatrist 213ES0103X 243983 KY Primary

Addresses

Primary practice location

4612 Outer Loop
Louisville, KY 40219-3971

Mailing address

4612 Outer Loop
Louisville, KY 40219-3971
Phone (502) 804-4811

Other identifiers 5

IdentifierTypeStateIssuer
50071771OtherKYPASSPORT HEALTH PLAN
7100307170MedicaidKY
201243030MedicaidIN
P01370863OtherINRAILROAD MEDICARE
000000880754OtherKYANTHEM

Other names 1

  • Amanda L Ray Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 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
I20140808000667 IN Practitioner - Podiatry 3173740594 Reassigns benefits to 1 organization
I20140822002364 KY Practitioner - Podiatry 3173740594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kentuckiana Foot and Ankle PLLCGroup PAC ID 4880752443, 14 clinicians

Practice addresses (Care Compare)

2818 Grant Line Rd
New Albany, IN 47150-2492
Phone (812) 725-7542

4420 Dixie Hwy
Suite 130
Louisville, KY 40216-2995
Phone (502) 805-3338

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.08 of 100Reported as individual
Quality
36.56
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue131
Removal of skin lesions42
Removal of nail tissue752
Removal or shaving of skin growth254
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
243983KYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kentuckiana Foot & Ankle PLLC Foot & Ankle Surgery CurrentSince Jul 1, 2014 Accepting new patients
Kentuckiana Foot & Ankle, PLLC Foot & Ankle Surgery CurrentSince Jul 1, 2014 Accepting new patients

Locations

2818 Grant Line Rd
New Albany, IN 47150
Phone (812) 725-7542

900 Chambers Blvd
Bardstown, KY 40004
Phone (502) 331-6309

1938 Lyda Ave
Bowling Green, KY 42104
Phone (270) 783-0064

3045 Ring Rd
Elizabethtown, KY 42701
Phone (270) 737-3338

2805 N Hurstbourne Pkwy
Ste 105
Louisville, KY 40223
Phone (502) 243-3668

4420 Dixie Hwy
Ste 130
Louisville, KY 40216
Phone (502) 805-3338

4612 Outer Loop
Louisville, KY 40219
Phone (502) 804-4811

6801 Dixie Hwy
Ste 134
Louisville, KY 40258
Phone (502) 447-4500

734 W Main St
Ste 106
Louisville, KY 40202
Phone (502) 653-5800

7397 Jefferson Blvd
Louisville, KY 40219
Phone (502) 805-3338

8017 Bardstown Rd
Ste 106
Louisville, KY 40291
Phone (502) 239-6600

Organizations & group practices 2

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

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1124316195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 OUTER LOOP",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193971",
            "telephone_number": "502-804-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 OUTER LOOP",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193971",
            "telephone_number": "502-968-2233",
            "fax_number": "502-968-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENZIK",
        "first_name": "AMANDA",
        "middle_name": "L",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-12",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07001180A",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KY",
            "license": "243983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH PLAN",
            "identifier": "50071771",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100307170",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201243030",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01370863",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000880754",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "RAY",
            "middle_name": "L",
            "credential": "DPM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.