NPIMap

Organization Active NPI

Middletown Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Louisville, KY
National Provider Identifier
1164645834
Registry record updated Mar 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
28883 Issued in KY
Legal business name
MIDDLETOWN PEDIATRICS
Practice address
301 C Middletown Park Place
Louisville, KY 40243
Phone
(502) 244-9858
Fax
(502) 244-9575
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2014

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

Authorized official

Name
Dr. Dana J. Distler, M.D.NPI 1700863230
Title
Physician/Owner
Phone
(502) 244-9858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 28883 KY Primary
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 38964 KY
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 39163 KY

Addresses

Primary practice location

301 C Middletown Park Place
Louisville, KY 40243

Mailing address

301 C Middletown Park Place
Louisville, KY 40243
Phone (502) 244-9858

National Provider Directory

National Provider Directory

Locations

301 Middletown Park Pl
Ste C
Louisville, KY 40243
Phone (502) 244-9858

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1164645834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 C MIDDLETOWN PARK PLACE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40243",
            "telephone_number": "502-244-9858",
            "fax_number": "502-244-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 C MIDDLETOWN PARK PLACE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40243",
            "telephone_number": "502-244-9858",
            "fax_number": "502-244-9575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLETOWN PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "DISTLER",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "502-244-9858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "KY",
            "license": "28883",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "KY",
            "license": "38964",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "KY",
            "license": "39163",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.