NPIMap

Individual provider Active NPI

Bradley Benson Humble

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1316257736
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3006761 Issued in KY
Practice address
530 S Jackson St
Louisville, KY 40202-1675
Phone
(502) 852-1735
Fax
(502) 852-6056
NPI assigned
Oct 19, 2010
Last updated
Apr 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3006761 KY Primary
Registered Nurse 163W00000X 1108550 KY

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

Other practice location 1

7702 Windgate Dr
Louisville, KY 40291-4222
Phone (502) 905-7417

Other identifiers 2

IdentifierTypeStateIssuer
201029430MedicaidIN
7100147700MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110203000244 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436339728 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

530 S Jackson St
Louisville, KY 40202-1675
Phone (502) 562-3000

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
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1108550KYMDRegistered Nurse
3006761KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 27, 2010 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince May 1, 2020 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince May 1, 2020 Accepting new patients
Professional Anesthesia Services of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2024 Accepting new patients

Locations

3423 Solutions Ctr
Chicago, IL 60677

7752 Solution Ctr
Chicago, IL 60677

1 Audubon Plaza Dr
Louisville, KY 40217
Phone (502) 634-6767

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

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

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 6

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1316257736",
    "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",
            "fax_number": "502-587-4784"
        },
        {
            "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": "502-852-1735",
            "fax_number": "502-852-6056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7702 Windgate Dr",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402914222",
            "country_code": "US",
            "telephone_number": "502-905-7417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMBLE",
        "first_name": "BRADLEY",
        "middle_name": "BENSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-19",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3006761",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1108550",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201029430",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100147700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 20, 2020; 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.