Individual provider Active NPI

Marina Sud

  • Clinical Psychologist
  • Louisville, KY
National Provider Identifier
1538230651
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1652 Issued in KY
Practice address
7400 New Lagrange Rd.
Ste 310
Louisville, KY 40222-4870
Phone
(914) 475-7256
NPI assigned
Nov 11, 2006
Last updated
Apr 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 014487-1 NY
Clinical Psychologist 103TC0700X 1652 KY Primary

Addresses

Primary practice location

7400 New Lagrange Rd.
Ste 310
Louisville, KY 40222-4870

Mailing address

7400 New Lagrange Rd.
Suite 310
Louisville, KY 40222-4870
Phone (914) 475-7256

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140325001191 KY Practitioner - Psychologist Billing Independently 2668464173 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1834 Gresham Rd
Louisville, KY 40205-2424
Phone (914) 475-7256

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1652KYMDSocial Worker
014487-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stress Reduction and Psychological Services, PC Clinical PastSince Nov 4, 2008 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: marina.sud.1@30520.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1538230651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LAGRANGE RD.",
            "address_2": "SUITE 310",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "914-475-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 NEW LAGRANGE RD.",
            "address_2": "STE 310",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "914-475-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUD",
        "first_name": "MARINA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-11",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014487-1",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "1652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 5, 2016; 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.