NPIMap

Individual provider Active NPI

Keith D Forwith, MD

  • Otolaryngology Physician
  • Louisville, KY
National Provider Identifier
1467458083
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
36650 Issued in KY
Practice address
4004 Dupont Cir
Suite 220
Louisville, KY 40207-4819
Phone
(502) 893-0159
Fax
(502) 213-3853
NPI assigned
Jun 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 36650 KY
Otolaryngology Physician 207Y00000X 36650 KY Primary
Otolaryngology Physician 207Y00000X 01054405A IN

Addresses

Primary practice location

4004 Dupont Cir
Suite 220
Louisville, KY 40207-4819

Mailing address

PO Box 950116
Louisville, KY 40295-0116
Phone (502) 893-0159

Other identifiers 2

IdentifierTypeStateIssuer
040015870OtherKYMEDICARE RR
64959729MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100210000170 KY Practitioner - Otolaryngology 4789727314 Reassigns benefits to 1 organization
I20100222000579 IN Practitioner - Otolaryngology 4789727314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Cincinnati College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced ENT and Allergy PLLCGroup PAC ID 2769525385, 37 clinicians

Practice addresses (Care Compare)

108 W Daisy LN
New Albany, IN 47150-4537
Phone 50289301591188

2944 Breckenridge LN
Louisville, KY 40220-1409
Phone 50289301591188

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.34 of 100Reported as group
Quality
89.81
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Merit Anesthesia PLLC CurrentSince Jan 31, 2024 Accepting new patients

Locations

108 W Daisy Ln
New Albany, IN 47150
Phone (812) 945-3557

2944 Breckenridge Ln
Louisville, KY 40220
Phone (502) 995-5525

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1467458083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950116",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950116",
            "telephone_number": "502-893-0159",
            "fax_number": "502-213-3853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 DUPONT CIR",
            "address_2": "SUITE 220",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074819",
            "telephone_number": "502-893-0159",
            "fax_number": "502-213-3853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORWITH",
        "first_name": "KEITH",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KY",
            "license": "36650",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "36650",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01054405A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "040015870",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64959729",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.