Individual provider Active NPI

Lynette Gillis, MD

  • Pediatric Gastroenterology Physician
  • Louisville, KY
National Provider Identifier
1316034432
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
57884 Issued in KY
Practice address
411 E Chestnut St Ste 5B
Louisville, KY 40202-1713
Phone
(502) 588-2330
Fax
(502) 588-9513
NPI assigned
Oct 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X MD38932 TN
Pediatric Gastroenterology Physician 2080P0206X 57884 KY Primary

Addresses

Primary practice location

411 E Chestnut St Ste 5B
Louisville, KY 40202-1713

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230207002207 KY Practitioner - Pediatric Medicine 2961463450 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57884KYMDPediatric Gastroenterology Physician
MD38932TNMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC Pediatric Gastroenterology CurrentSince Feb 1, 2023 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Feb 1, 2023 Accepting new patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Norton Childrens Medical Group, LLC Past Accepting new patients

Locations

411 E Chestnut St
#5B
Louisville, KY 40202
Phone (502) 588-2330

4910 Chamberlain Ln
Louisville, KY 40241
Phone (502) 446-5000

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

9880 Angies Way
Ste 330
Louisville, KY 40241
Phone (502) 588-2220

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

411 E Chestnut St
Ste 5B
Louisville, KY 40202
Phone (502) 588-2330

Interoperability endpoints

  • Direct secure messaging: lgillis249422@direct.nortonhealthcare.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1316034432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E CHESTNUT ST STE 5B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021713",
            "telephone_number": "502-588-2330",
            "fax_number": "502-588-9513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "LYNETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-09",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TN",
            "license": "MD38932",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "KY",
            "license": "57884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.