NPIMap

Individual provider Active NPI

Jeffrey P. Callen, M.D.

  • Dermatology Physician
  • Louisville, KY
National Provider Identifier
1508872821
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
18911 Issued in KY
Practice address
3810 Springhurst Blvd
Suite 200
Louisville, KY 40241-6100
Phone
(502) 583-1749
Fax
(502) 329-8184
NPI assigned
Jul 31, 2006
Last updated
Jul 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 18911 KY Primary

Addresses

Primary practice location

3810 Springhurst Blvd
Suite 200
Louisville, KY 40241-6100

Mailing address

PO Box 950132
Louisville, KY 40295-0132
Phone (888) 980-8992

Other identifiers 2

IdentifierTypeStateIssuer
100347190MedicaidIN
64189111MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100728001036 KY Practitioner - Dermatology 9436041662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Michigan Medical School, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associates in Dermatology, PLLCGroup PAC ID 1658263876, 37 clinicians

Practice addresses (Care Compare)

9336 Cedar Ctr Way
Louisville, KY 40291-4522
Phone (502) 583-1749

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions487
Removal or shaving of skin growth1-10
Skin biopsy63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18911KYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associates in Dermatology, PLLC Dermatology CurrentSince Apr 2, 1993 Accepting new patients
University Physicians Group - Radiology Past Accepting new patients

Locations

700 Portland Ave
Ste B
Bardstown, KY 40004
Phone (270) 234-6695

325 W Walnut St
Ste 300
Lebanon, KY 40033
Phone (270) 692-0735

506 S Main St
Leitchfield, KY 42754
Phone (270) 200-1095

3810 Springhurst Blvd
Louisville, KY 40241
Phone (502) 322-1954

3810 Springhurst Blvd
Ste 200
Louisville, KY 40241
Phone (317) 780-7400

9336 Cedar Center Way
Louisville, KY 40291
Phone 50242616211212

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1508872821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950132",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950132",
            "telephone_number": "888-980-8992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 SPRINGHURST BLVD",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402416100",
            "telephone_number": "502-583-1749",
            "fax_number": "502-329-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLEN",
        "first_name": "JEFFREY",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KY",
            "license": "18911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100347190",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64189111",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.