NPIMap

Organization Active NPI

Pearl Geriatrics and Palliative Medicine, PSC

  • Geriatric Medicine (Internal Medicine) Physician
  • Louisville, KY
National Provider Identifier
1376865972
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
PEARL GERIATRICS AND PALLIATIVE MEDICINE, PSC
Practice address
2202 Buechel Ave Ste 105
Louisville, KY 40218-2672
Phone
(502) 456-0494
Fax
(504) 456-0496
NPI assigned
Feb 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Authorized official

Name
Dr. Osawaru Jude Omoruyi, M.D.NPI 1396961967
Title
Owner
Phone
(502) 456-0494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 39870 KY
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 3006777 KY

Addresses

Primary practice location

2202 Buechel Ave Ste 105
Louisville, KY 40218-2672

Mailing address

PO Box 37188
Louisville, KY 40233-7188
Phone (502) 456-0494

Other practice location 1

6512 Baum Dr Ste 4
Knoxville, TN 37919-7333
Phone (502) 456-0494

Other identifiers 2

IdentifierTypeStateIssuer
7100159350MedicaidKY
7100134680MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100517000606 KY Part B Supplier - Clinic/Group Practice 6103954847 Receives reassigned benefits from 18 practitioners
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory
Tax ID family
Pearl Medical Practice PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1705 Herr Ln
Louisville, KY 40222
Phone (502) 426-5600

2210 Goldsmith Ln
Ste 103
Louisville, KY 40218

2902 Bardstown Rd
Ste D
Louisville, KY 40205
Phone (502) 808-1048

2202 Buechel Ave
Ste 105
Louisville, KY 40218
Phone 50245604944010

2210 Goldsmith Ln
Ste 105
Louisville, KY 40218
Phone (502) 479-1002

6512 Baum Dr
Ste 4
Knoxville, TN 37919

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1376865972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37188",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402337188",
            "telephone_number": "502-456-0494",
            "fax_number": "502-456-0496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 BUECHEL AVE STE 105",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182672",
            "telephone_number": "502-456-0494",
            "fax_number": "504-456-0496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6512 Baum Dr Ste 4",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379197333",
            "country_code": "US",
            "telephone_number": "502-456-0494",
            "fax_number": "502-456-0496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEARL GERIATRICS AND PALLIATIVE MEDICINE, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-23",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "OMORUYI",
        "authorized_official_first_name": "OSAWARU",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-456-0494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "39870",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3006777",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100159350",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100134680",
            "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 Jan 29, 2021; 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.