Active NPI
David Madewell
- Dentist
- Louisville, KY
National Provider Identifier
1285000562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 122300000X
- Practice address
- 1044 Alta Vista Rd
Louisville, KY 40205-1758 - Phone
- (270) 315-6690
- NPI assigned
- Aug 20, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 122300000X | KY | Primary |
Addresses
Primary practice location
1044 Alta Vista Rd
Louisville, KY 40205-1758
Mailing address
1044 Alta Vista Rd
Louisville, KY 40205-1758
Phone (270) 315-6690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1001703746 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122300000X | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440028800000",
"number": "1285000562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1044 ALTA VISTA RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402051758",
"telephone_number": "270-315-6690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1044 ALTA VISTA RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402051758",
"telephone_number": "270-315-6690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADEWELL",
"first_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-20",
"last_updated": "2015-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "122300000X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1001703746",
"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 Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.