NPIMap

Individual provider Active NPI

Colin Michael Carroll, M.D.

  • Diagnostic Radiology Physician
  • Louisville, KY
National Provider Identifier
1295091148
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
50836 Issued in KY
Practice address
4000 Kresge Way
Louisville, KY 40207-4605
Phone
(502) 897-9281
NPI assigned
Apr 4, 2012
Last updated
Jul 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 49643 TN
Diagnostic Radiology Physician 2085R0202X 50836 KY Primary
Body Imaging Physician 2085B0100X 49643 TN

Addresses

Primary practice location

4000 Kresge Way
Louisville, KY 40207-4605

Mailing address

702 Executive Park
Louisville, KY 40207-4207
Phone (502) 895-5405

Other identifiers 1

IdentifierTypeStateIssuer
7100505170MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180524002933 KY Practitioner - Diagnostic Radiology 2961774997 Reassigns benefits to 2 organizations
I20260413001640 IN Practitioner - Diagnostic Radiology 2961774997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Louisville School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
X-Ray Associates of Louisville PSCGroup PAC ID 9436146818, 55 clinicians

Practice addresses (Care Compare)

4000 Kresge Way
Louisville, KY 40207-4605
Phone (502) 897-8121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49643TNMDBody Imaging Physician
50836KYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
X-Ray Associates of Louisville PSC Diagnostic Radiology CurrentSince Jul 1, 2018 Accepting new patients
Tuhc Radiology Group LLC Diagnostic Radiology PastSince Jul 1, 2017 Accepting new patients
Radiology Associates Inc Diagnostic Radiology Past Accepting new patients

Locations

702 Executive Park
Louisville, KY 40207

4000 Kresge Way
St Matthews, KY 40207
Phone (502) 459-7902

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

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1295091148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 EXECUTIVE PARK",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074207",
            "telephone_number": "502-895-5405",
            "fax_number": "502-894-9544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 KRESGE WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074605",
            "telephone_number": "502-897-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "COLIN",
        "middle_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-04",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "49643",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "50836",
            "primary": true
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "TN",
            "license": "49643",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100505170",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.