Individual provider Active NPI

John Paul Z Magenis, PA

  • Medical Physician Assistant
  • Louisville, KY
National Provider Identifier
1225360795
Registry record updated Jan 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2153 Issued in KY
Practice address
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone
(502) 634-6767
Fax
(502) 634-6775
NPI assigned
Feb 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2153 KY Primary

Addresses

Primary practice location

1 Audubon Plaza Dr
Louisville, KY 40217-1318

Mailing address

PO Box 36218
Louisville, KY 40233-6218
Phone (502) 634-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181113002326 MA Practitioner - Physician Assistant 3375792922 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
013848NYMDChiropractor
PA2153KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Hospital CurrentSince Sep 16, 2018 Accepting new patients
Fairview Hospital CurrentSince Sep 16, 2018 Accepting new patients

Locations

29 Lewis Ave
Gt Barrington, MA 01230
Phone (413) 528-0790

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.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1225360795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36218",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402336218",
            "telephone_number": "502-634-6767",
            "fax_number": "502-634-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171318",
            "telephone_number": "502-634-6767",
            "fax_number": "502-634-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGENIS",
        "first_name": "JOHN PAUL",
        "middle_name": "Z",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-08",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA2153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.