Individual provider Active NPI

Kenneth Randal Pearson, MD

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1215029103
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
39864 Issued in KY
Practice address
9880 Angies Way Ste 400
Louisville, KY 40241-2850
Phone
(502) 394-6500
Fax
(502) 394-1920
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 39864 KY Primary

Addresses

Primary practice location

9880 Angies Way Ste 400
Louisville, KY 40241-2850

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 272-5395

Other identifiers 3

IdentifierTypeStateIssuer
64115017MedicaidKY
000000501261OtherKYANTHEM
50009443OtherKYPASSPORT HEALTH PLAN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kpearson44999@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140205001365 KY Practitioner - Pediatric Medicine 7618106014 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norton Childrens Medical Group LLCGroup PAC ID 3779917596, 234 clinicians

Practice addresses (Care Compare)

601 S Floyd St
Suite 604
Louisville, KY 40202-1874
Phone (502) 559-1670

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.07
Promoting interoperability
100
Improvement activities
40
Cost
76.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39864KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Community Medical Associates, Inc. Pediatrics CurrentSince Jan 1, 2014 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics Past Accepting new patients

Locations

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

9880 Angies Way
Ste 410
Louisville, KY 40241
Phone (502) 394-6511

9880 Angies Way
Ste 400
Louisville, KY 40241
Phone (502) 394-6500

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

Interoperability endpoints

  • Direct secure messaging: kpearson44999@direct.nortonhealthcare.org

Organizations & group practices 7

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1215029103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-272-5395",
            "fax_number": "502-272-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9880 ANGIES WAY STE 400",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412850",
            "telephone_number": "502-394-6500",
            "fax_number": "502-394-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "KENNETH",
        "middle_name": "RANDAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "39864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64115017",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000501261",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH PLAN",
            "identifier": "50009443",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpearson44999@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "9880 Angies way",
            "address_2": "ste 400",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402412850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/",
            "affiliation": "N",
            "address_1": "9880 Angies way",
            "address_2": "ste 400",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402412850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.