NPIMap

Individual provider Active NPI

Kristal Lee Ann Wilson, MD

  • Interventional Pain Medicine Physician
  • Louisville, KY
National Provider Identifier
1578853602
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
48792 Issued in KY
Practice address
10302 Brookridge Village Blvd Ste 103-104
Louisville, KY 40291-4475
Phone
(502) 276-5300
Fax
(502) 576-5376
NPI assigned
Apr 11, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 01084557A IN
Interventional Pain Medicine Physician 208VP0014X 48792 KY Primary

Addresses

Primary practice location

10302 Brookridge Village Blvd Ste 103-104
Louisville, KY 40291-4475

Mailing address

10302 Brookridge Village Blvd Ste 103-104
Louisville, KY 40291-4475
Phone (502) 576-5300

Other identifiers 2

IdentifierTypeStateIssuer
7100212070MedicaidKY
201298810MedicaidIN

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
I20160810002831 KY Practitioner - Interventional Pain ManagementPractitioner - Pain Management 9830403161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Pain Management
Education
University of Louisville School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

10302 Brookridge Village Blvd
Suite 103 104
Louisville, KY 40291-4475
Phone (502) 576-5300

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pain and Wellness Institute of Kentucky LLC General Practice CurrentSince Mar 1, 2023 Accepting new patients
Aptiva Health Sports Medicine LLC PastSince Jul 10, 2023 Accepting new patients

Locations

10302 Brookridge Village Blvd
Ste 103
Louisville, KY 40291

10302 Brookridge Village Blvd
Ste 104
Louisville, KY 40291

10302 Brookridge Village Blvd
Ste 103104
Louisville, KY 40291
Phone (502) 276-5300

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1578853602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10302 BROOKRIDGE VILLAGE BLVD STE 103-104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402914475",
            "telephone_number": "502-576-5300",
            "fax_number": "502-576-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10302 BROOKRIDGE VILLAGE BLVD STE 103-104",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402914475",
            "telephone_number": "502-276-5300",
            "fax_number": "502-576-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KRISTAL",
        "middle_name": "LEE ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "01084557A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "KY",
            "license": "48792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100212070",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201298810",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.