NPIMap

Individual provider Active NPI

Kaitlyn Diane Tucker, PA-C

  • Endocrinology, Diabetes & Metabolism Physician
  • Louisville, KY
National Provider Identifier
1225390891
Registry record updated Nov 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
006465 Issued in GA
Practice address
6400 Dutchmans Pkwy Ste 345
Louisville, KY 40205-3370
Phone
(502) 587-6010
Fax
(502) 587-1314
NPI assigned
Jun 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X KY
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 006465 GA Primary

Addresses

Primary practice location

6400 Dutchmans Pkwy Ste 345
Louisville, KY 40205-3370

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 587-6010

Other practice location 1

1800 Howell Mill Rd NW
Suite 450
Atlanta, GA 30318-2538
Phone (404) 355-4393

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
I20201208001306 KY Practitioner - Physician Assistant 2961668710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

571 S Floyd St
Louisville, KY 40202-3818
Phone (502) 629-2398

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. Physician Assistant CurrentSince Dec 7, 2020 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Dec 7, 2020 Accepting new patients
Van Meter Pediatric Endocrinology PastSince Jan 26, 2022 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

6400 Dutchmans Pkwy
Ste 345
Louisville, KY 40205
Phone (502) 315-1450

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Organizations & group practices 4

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 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605312000000",
    "number": "1225390891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-587-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY STE 345",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053370",
            "telephone_number": "502-587-6010",
            "fax_number": "502-587-1314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Howell Mill Rd NW",
            "address_2": "Suite 450",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303182538",
            "country_code": "US",
            "telephone_number": "404-355-4393",
            "fax_number": "678-412-0086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "KAITLYN",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-11",
        "last_updated": "2020-11-14",
        "certification_date": "2020-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "GA",
            "license": "006465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.