NPIMap

Individual provider Active NPI

Jackie Smith

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1588030688
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3009478 Issued in KY
Practice address
215 Central Ave Ste 100
Louisville, KY 40208-1450
Phone
(502) 588-8720
NPI assigned
Aug 12, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3009478 KY
Family Nurse Practitioner 363LF0000X 3009478 KY Primary

Addresses

Primary practice location

215 Central Ave Ste 100
Louisville, KY 40208-1450

Mailing address

PO Box 909
Louisville, KY 40201-0909

Other identifiers 1

IdentifierTypeStateIssuer
7100373600MedicaidKY

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
I20150915003380 KY Practitioner - Nurse Practitioner 6608183165 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
TBD Acquisition LLCGroup PAC ID 7911085006, 2 clinicians
University of Louisville Physicians IncGroup PAC ID 3476725599, 1,438 clinicians

Practice addresses (Care Compare)

1405 Browns LN
Louisville, KY 40207-4608
Phone (502) 896-0495

401 E Chestnut St
Suite 510
Louisville, KY 40202-5700
Phone (502) 589-0802

Hospital & facility affiliations

  • UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Hospital, Louisville, KY, CCN 180040
  • University of Louisville Hospital Hospital, Louisville, KY, CCN 180141

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Oct 10, 2019 Accepting new patients
TBD Acquisition, LLC CurrentSince Feb 3, 2022 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Oct 10, 2019 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

215 Central Ave
Louisville, KY 40208
Phone (502) 588-4521

215 Central Ave
Ste 100
Louisville, KY 40208
Phone (502) 588-8720

1405 Browns Ln
Louisville, KY 40207
Phone (502) 896-0495

401 E Chestnut St
Unit 510
Louisville, KY 40202
Phone (502) 588-4800

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Interoperability endpoints

  • Direct secure messaging: jsmith23711@uoflhealth-dm.org

Organizations & group practices 4

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1588030688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 CENTRAL AVE STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402081450",
            "telephone_number": "502-588-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACKIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-12",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3009478",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3009478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100373600",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.