NPIMap

Organization Active NPI

Commonwealth of Kentucky

Doing business as Central State Hospital

  • Psychiatric Hospital
  • Louisville, KY
National Provider Identifier
1578871679
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
COMMONWEALTH OF KENTUCKY
Doing business as
Central State Hospital
Practice address
10510 Lagrange Road
Louisville, KY 40223
Phone
(502) 253-7000
Fax
(503) 253-7044
NPI assigned
Sep 23, 2010
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONWEALTH OF KENTUCKYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Jennifer Moore
Title
Assistant Director
Phone
(502) 782-6117

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU
Psychiatric Hospital 283Q00000X KY Primary
Psychiatry Physician 2084P0800X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

10510 Lagrange Road
Louisville, KY 40223

Mailing address

10510 Lagrange Road
Louisville, KY 40223
Phone (502) 253-7000

Other identifiers 1

IdentifierTypeStateIssuer
02021293MedicaidKY

Other names 1

  • Central State Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040816000397 KY Part B Supplier - Clinic/Group Practice 9436122710 Receives reassigned benefits from 69 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, KY; Somerset, KY; Lexington, KY; Hopkinsville, KY
O20080312000753 KY Part A Provider - Hospital 0840180816 1 other NPI on this enrollment
Practice locations: Louisville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578871679. Details of each certification follow.

Hospital certification: CCN 184015

Legal name
COMMONWEALTH OF KENTUCKY
Doing business as
CENTRAL STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 30, 1987
Last certification
Jun 13, 2007
Beds
192
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
10510 La Grange Rd
Louisville, KY 40223-1277
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Central State HospitalCCN 184015 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth of Kentucky126 organizations share this tax ID, including this one
Part of
Commonwealth of Kentucky

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Commonwealth of Kentucky Organization, Frankfort, KY 5% Or Greater Direct Ownership Interest Jun 1, 1992 100%
Matt Mooring Individual Corporate DirectorHospital Director Mar 7, 2019
Jennifer Moore Individual Operational/Managerial ControlAssistant Director May 1, 2015
Mathew Gayheart Individual Corporate DirectorDirector of Finance Jan 10, 2013
Katrice D Maddox Individual Operational/Managerial ControlBhdid Program Administrator Jun 1, 2015

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1578871679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10510 LAGRANGE ROAD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40223",
            "telephone_number": "502-253-7000",
            "fax_number": "503-253-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10510 LAGRANGE ROAD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40223",
            "telephone_number": "502-253-7000",
            "fax_number": "503-253-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF KENTUCKY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF KENTUCKY",
        "enumeration_date": "2010-09-23",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "502-782-6117"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02021293",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.