NPIMap

Organization Active NPI

Louisville Jefferson County Metro Government

Doing business as Jefferson County Immunization Int Project

  • Public Health or Welfare Agency
  • Louisville, KY
National Provider Identifier
1316072689
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
251K00004 Issued in KY
Legal business name
LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Doing business as
Jefferson County Immunization Int Project
Practice address
400 E Gray St
Louisville, KY 40202-1740
Phone
(502) 574-5652
Fax
(502) 574-6417
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Authorized official

Name
Ms. Robyn Dickerson, MSM
Title
Fiscal Manager
Phone
(502) 574-6580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 251K00004 KY Primary

Addresses

Primary practice location

400 E Gray St
Louisville, KY 40202-1740

Mailing address

400 E Gray St
P.O.Box 1704
Louisville, KY 40202-1740
Phone (502) 574-6514

Other identifiers 2

IdentifierTypeStateIssuer
20056099MedicaidKY
1051428OtherKYPASSPORT MANAGED CARE NUM

Other names 1

  • Jefferson County Immunization Int Project Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240604002137 KY Part B Supplier - Clinic/Group Practice 9537064951 Receives reassigned benefits from 2 practitioners
5 other NPIs on this enrollment
Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1316072689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E GRAY ST",
            "address_2": "P.O.BOX 1704",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021740",
            "telephone_number": "502-574-6514",
            "fax_number": "502-574-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E GRAY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021740",
            "telephone_number": "502-574-5652",
            "fax_number": "502-574-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "FISCAL MANAGER",
        "authorized_official_telephone_number": "502-574-6580",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSM"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "KY",
            "license": "251K00004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20056099",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT MANAGED CARE NUM",
            "identifier": "1051428",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson County Immunization Int Project",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.