NPIMap

Organization Active NPI

Community Care of Kentucky, Inc.

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1215327994
Registry record updated Feb 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
COMMUNITY CARE OF KENTUCKY, INC.
Practice address
3438 Taylor Blvd
Louisville, KY 40215-2648
Phone
(502) 366-4442
Fax
(502) 366-4446
NPI assigned
Feb 2, 2015
Last updated
Feb 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2016

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

Authorized official

Name
Todd Cruse
Title
President
Phone
(629) 999-5006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3438 Taylor Blvd
Louisville, KY 40215-2648

Mailing address

3438 Taylor Blvd
Louisville, KY 40215-2648
Phone (502) 366-4442

Other identifiers 2

IdentifierTypeStateIssuer
50086402OtherKYPASSPORT KY
7100348540MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Community Care of Kentucky Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1215327994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3438 TAYLOR BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402152648",
            "telephone_number": "502-366-4442",
            "fax_number": "502-366-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3438 TAYLOR BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402152648",
            "telephone_number": "502-366-4442",
            "fax_number": "502-366-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF KENTUCKY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-02",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "CRUSE",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "629-999-5006"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT KY",
            "identifier": "50086402",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100348540",
            "state": "KY"
        }
    ],
    "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 Feb 4, 2016; 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.