Individual provider Active NPI

Kaitlin Brooke Firquin, DO

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1245817279
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
05761 Issued in KY
Practice address
231 E Chestnut St
Louisville, KY 40202-1821
Phone
(502) 629-6000
NPI assigned
Mar 25, 2021
Last updated
Sep 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 05761 KY Primary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 05761 KY

Addresses

Primary practice location

231 E Chestnut St
Louisville, KY 40202-1821

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other names 1

  • Kaitlin Brooke Mardis Former name

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
I20241024003285 KY Practitioner - Pediatric Medicine 9830593466 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05761KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children's Medical Group, LLC Current Accepting new patients
Norton Children's Medical Group, LLC Pediatrics CurrentSince Nov 20, 2024 Accepting new patients
Norton Children's Medical Group, LLC CurrentSince Nov 20, 2024 Accepting new patients

Locations

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1245817279",
    "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": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 E CHESTNUT ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021821",
            "telephone_number": "502-629-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIRQUIN",
        "first_name": "KAITLIN",
        "middle_name": "BROOKE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "05761",
            "primary": true
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "KY",
            "license": "05761",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "MARDIS",
            "middle_name": "BROOKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.