NPIMap

Individual provider Active NPI

Spencer Ryan Idstein, M.D.

  • Internal Medicine Physician
  • Prospect, KY
National Provider Identifier
1205194693
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
49531 Issued in KY
Practice address
6341 Meeting St Ste 102
Prospect, KY 40059-8731
Phone
(502) 566-0300
NPI assigned
Apr 24, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 49531 KY
Internal Medicine Physician 207R00000X 49531 KY Primary

Addresses

Primary practice location

6341 Meeting St Ste 102
Prospect, KY 40059-8731

Mailing address

6341 Meeting St Ste 102
Prospect, KY 40059-8731
Phone (502) 566-0300

Other identifiers 1

IdentifierTypeStateIssuer
7100439060MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160912001660 KY Practitioner - Internal Medicine 1951551431 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Louisville School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine and Pediatric Partners PLLCGroup PAC ID 9133572167, 2 clinicians

Practice addresses (Care Compare)

6341 Meeting St
Unit 102
Prospect, KY 40059-8761
Phone (502) 566-0300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Nov 1, 2020 Accepting new patients
Internal Medicine and Pediatric Partners, PLLC Internal Medicine CurrentSince Sep 26, 2024 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Nov 1, 2020 Accepting new patients

Locations

96 Future Dr
Corbin, KY 40701

7101 W Highway 22
Crestwood, KY 40014
Phone (502) 241-6467

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

648 University Shopping Ctr
Richmond, KY 40475
Phone (859) 623-1950

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1205194693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6341 MEETING ST STE 102",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400598731",
            "telephone_number": "502-566-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6341 MEETING ST STE 102",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400598731",
            "telephone_number": "502-566-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDSTEIN",
        "first_name": "SPENCER",
        "middle_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-24",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "49531",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "49531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100439060",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prospect, KY

Sources for this page

Verify at the official NPI Registry.