Active NPI
Kyle Brandon Polley, STUDENT
- Sports Medicine (Family Medicine) Physician
- La Grange, KY
National Provider Identifier
1396302535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 61083
- Practice address
- 1023 New Moody LN Ste 102
La Grange, KY 40031-9183 - Phone
- (502) 222-0598
- Fax
- (502) 222-7446
- NPI assigned
- May 23, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 61083 | KY | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1023 New Moody LN Ste 102
La Grange, KY 40031-9183
Mailing address
1901 Campus PL
Louisville, KY 40299-2308
Phone (502) 222-0598
Other practice location 1
500 S Preston St Rm 305
Louisville, KY 40202-1702
Phone (502) 852-8696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390200000X | Other | ULSOM |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231106001308 | KY | Order and Referring Only - Family Practice | 6406203926 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787011200000",
"number": "1396302535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 CAMPUS PL",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402992308",
"telephone_number": "502-222-0598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1023 NEW MOODY LN STE 102",
"city": "LA GRANGE",
"state": "KY",
"postal_code": "400319183",
"telephone_number": "502-222-0598",
"fax_number": "502-222-7446"
}
],
"practiceLocations": [
{
"address_1": "500 S Preston St Rm 305",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402021702",
"country_code": "US",
"telephone_number": "502-852-8696",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POLLEY",
"first_name": "KYLE",
"middle_name": "BRANDON",
"credential": "STUDENT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-23",
"last_updated": "2026-08-18",
"certification_date": "2026-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "KY",
"license": "61083",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ULSOM",
"identifier": "390200000X",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in La Grange, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.