NPIMap

Organization Active NPI

Baymark Health Services of Kentucky, Inc.

Doing business as MedMark Treatment Centers Louisville

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Louisville, KY
National Provider Identifier
1427639608
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
BAYMARK HEALTH SERVICES OF KENTUCKY, INC.
Doing business as
MedMark Treatment Centers Louisville
Practice address
4922 Poplar Level Rd
Louisville, KY 40219-1128
Phone
(502) 434-4466
Fax
(502) 434-4467
NPI assigned
Apr 19, 2021
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

4922 Poplar Level Rd
Louisville, KY 40219-1128

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (214) 379-3300

Other names 1

  • MedMark Treatment Centers Louisville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Opioid treatment program
Medicare-enrolled since Aug 18, 2022

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221128001560 KY Part B Supplier - Opioid Treatment Program (Otp) 9032587944 Practice locations: Louisville, KY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2169460Baymark Health Services of Kentucky, Inc4922 Poplar Rd, Louisville, KY 40219Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory

Locations

4922 Poplar Level Rd
Louisville, KY 40219
Phone (502) 434-5566

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1427639608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300",
            "fax_number": "214-853-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4922 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402191128",
            "telephone_number": "502-434-4466",
            "fax_number": "502-434-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYMARK HEALTH SERVICES OF KENTUCKY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-19",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Louisville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedMark Treatment Centers Louisville",
            "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 Jul 29, 2024; 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.