NPIMap

Individual provider Active NPI

Martin Thomas Logsdon, MD

  • Dermatology Physician
  • Louisville, KY
National Provider Identifier
1538110424
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20406 Issued in KY
Practice address
1700 Bluegrass Avenue
Suite 300
Louisville, KY 40215
Phone
(502) 363-1841
Fax
(502) 366-3317
NPI assigned
May 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

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 20406 KY Primary

Addresses

Primary practice location

1700 Bluegrass Avenue
Suite 300
Louisville, KY 40215

Mailing address

1700 Bluegrass Avenue
Suite 300
Louisville, KY 40215
Phone (502) 363-1841

Other identifiers 3

IdentifierTypeStateIssuer
64204068MedicaidKY
1069483OtherPASSPORT
000000047754OtherANTHEM

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
I20141211001616 KY Practitioner - Dermatology 8426033127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Louisville School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1700 Old Bluegrass Ave
Suite 300
Louisville, KY 40215-1175
Phone (502) 386-8792

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Skin biopsy18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20406KYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Louisville Dermatology ASC PSC Dermatology CurrentSince Oct 1, 1984 Accepting new patients
Associates in Dermatology, PLLC Dermatology Past Accepting new patients

Locations

1700 Old Bluegrass Ave
Louisville, KY 40215
Phone (502) 363-1841

1700 Old Bluegrass Ave
Ste 300
Louisville, KY 40215
Phone (502) 361-0288

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1538110424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 BLUEGRASS AVENUE",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-363-1841",
            "fax_number": "502-366-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 BLUEGRASS AVENUE",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-363-1841",
            "fax_number": "502-366-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGSDON",
        "first_name": "MARTIN",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KY",
            "license": "20406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64204068",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1069483",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000047754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.