Interventional Rehabilitation of Kentucky, P.S.C

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

INTERVENTIONAL REHABILITATION OF KENTUCKY, P.S.C

Practice address

315 E Broadway
Suite 250
Louisville, KY 40202-3700

Phone

(502) 589-4765

Fax

(502) 589-4799

NPI assigned

Aug 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ricky Stanley Collis, MDNPI 1144231291

Title

Owner

Phone

(502) 589-4765

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ricky Stanley Collis, MD

  • Pain Medicine Physician
  • Louisville, KY
  • NPI 1144231291

  IN

  Medicare reassignment Care Compare group NPD Authorized official
• Dean Stanley Collis, MD

  • Pain Medicine Physician
  • Louisville, KY
  • NPI 1477560530

  IN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1275549842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E BROADWAY",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023700",
            "telephone_number": "502-589-4765",
            "fax_number": "502-589-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E BROADWAY",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023700",
            "telephone_number": "502-589-4765",
            "fax_number": "502-589-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL REHABILITATION OF KENTUCKY, P.S.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "COLLIS",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-589-4765",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200279470A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1103005",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2322033",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943870",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "372286700",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charlotte Rose Ipsan, ARNP MSN
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• Pain Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pain Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.