Wayne Nelson Stark Jr., M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

45095 Issued in KY

Practice address

4001 Dutchmans LN
Louisville, KY 40207-4714

Phone

(502) 599-3930

Fax

(502) 559-4605

NPI assigned

Sep 25, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Norton Children's Medical Group, LLC

  dba Norton Children's Behavioral and Mental Health

  • Psychiatry Physician
  • Louisville, KY
  • NPI 1457999096
  Medicare reassignment NPD
• Norton Children's Medical Group, LLC

  dba Norton Children's Emergency Medicine

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Louisville, KY
  • NPI 1487292033
  NPD
• Norton Children's Medical Group, LLC

  dba Norton Children's Radiologists

  • Pediatric Radiology Physician
  • Louisville, KY
  • NPI 1659913812
  NPD

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

{
    "created_epoch": "1285372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1215246202",
    "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": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 DUTCHMANS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074714",
            "telephone_number": "502-599-3930",
            "fax_number": "502-559-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "WAYNE",
        "middle_name": "NELSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-25",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "45095",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME123631",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "KY",
            "license": "45095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Star Health Club Limited Liability Company
• Star Med of Kentucky LLC (Star Med Home Care)
• Collin Stark
• Leah Ryan Stark, PHARM D
• Linda Stark
• Kyle Matthew Starkey, OD
• Starks Spine & Rehab
• Candice A Starks, LPCA
• Desiree Starks, LPCC
• Angie Starling, LPCA

• Pediatric Emergency Medicine (Pediatrics) Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.