Individual provider Active NPI

Brian Keith Gackenbach, APRN

  • Acute Care Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1306229349
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
3009514 Issued in KY
Practice address
530 S Jackson St
Louisville, KY 40202-1675
Phone
(502) 217-1053
NPI assigned
Jul 8, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 3009514 KY Primary

Addresses

Primary practice location

530 S Jackson St
Louisville, KY 40202-1675

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 588-0328

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150909000353 KY Practitioner - Nurse Practitioner 8325354293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Maryland School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

529 S Jackson St
Suite 416
Louisville, KY 40202-3229
Phone (502) 852-7093

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Jul 21, 2015 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jul 21, 2015 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

529 S Jackson St
#416
Louisville, KY 40202
Phone (502) 852-7093

401 E Chestnut St
Unit 610
Louisville, KY 40202
Phone (502) 588-4450

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1306229349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S JACKSON ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021675",
            "telephone_number": "502-217-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GACKENBACH",
        "first_name": "BRIAN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-08",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3009514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.