Kentucky Medical Specialists, PSC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

36325 Issued in KY

Legal business name

KENTUCKY MEDICAL SPECIALISTS, PSC

Practice address

4001 Kresge Way Ste # 236
Louisville, KY 40207

Phone

(502) 893-7372

Fax

(502) 409-4715

NPI assigned

Jul 10, 2012

Organization subpart

No

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

Authorized official

Name

Marlon R Chagua, MDNPI 1407811870

Title

President

Phone

(502) 893-7372

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18405/brand/1/csg/1/fhir/r4

Practitioners 4

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

• Marlon R Chagua, M.D.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1407811870

  Internal Medicine, KY

  Medicare reassignment Care Compare group NPD Authorized official
• Hannah Olivia Jazdzewski, MSN, AGPCNP

  • Gerontology Nurse Practitioner
  • Louisville, KY
  • NPI 1194441113

  Adult Health, KY

  Medicare reassignment Care Compare group NPD
• James Packer, APRN

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1730835968

  KY

  Medicare reassignment NPD
• Debra Strotman, APRN

  • Adult Health Nurse Practitioner
  • Louisville, KY
  • NPI 1679608152

  Adult Health, KY

  Medicare reassignment NPD

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1295090884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 KRESGE WAY STE # 236",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40207",
            "telephone_number": "502-893-7372",
            "fax_number": "502-409-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 KRESGE WAY STE # 236",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40207",
            "telephone_number": "502-893-7372",
            "fax_number": "502-409-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY MEDICAL SPECIALISTS, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "CHAGUA",
        "authorized_official_first_name": "MARLON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-893-7372",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "36325",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64063266",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100235310",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kentucky Injury & Rehab LLC
• Kentucky Injury Care Centers, LLC
• Kentucky Joint Specialists LLC
• Kentucky Life Source Inc
• Kentucky Lions Eye Foundation, Inc.
• Kentucky Mental Health Care, L.L.C.
• Kentucky Neuro Associates
• Kentucky OB Hospitalist Services Inc
• Kentucky on-Site Dental Services LLC
• Kentucky Optical Company LLC

• Internal Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.