NPIMap

Individual provider Active NPI

Elizabeth Self Burckardt, MD

  • Otolaryngology Physician
  • Louisville, KY
National Provider Identifier
1588081749
Registry record updated May 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
53577 Issued in KY
Practice address
6420 Dutchmans Pkwy Ste 380
Louisville, KY 40205-3355
Phone
(502) 894-8441
Fax
(502) 894-4453
NPI assigned
Mar 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 53577 KY Primary

Addresses

Primary practice location

6420 Dutchmans Pkwy Ste 380
Louisville, KY 40205-3355

Mailing address

6420 Dutchmans Pkwy
Ste 380
Louisville, KY 40205-3355
Phone (502) 894-9753

Other names 1

  • Elizbaeth Mary Self Former name

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
I20200513002588 KY Practitioner - Otolaryngology 8921336470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Louisville Physicians IncGroup PAC ID 3476725599, 1,438 clinicians

Practice addresses (Care Compare)

9931 Forest Green Blvd
Louisville, KY 40223-5123
Phone (502) 588-0750

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088
  • UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Hospital, Louisville, KY, CCN 180040
  • University of Louisville Hospital Hospital, Louisville, KY, CCN 180141
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Uofl Health - Shelbyville Hospital Hospital, Shelbyville, KY, CCN 180016

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53577KYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc Otolaryngology CurrentSince Apr 1, 2025 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Apr 1, 2025 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

1263 Hospital Dr NW
Ste 100
Corydon, IN 47112
Phone (502) 888-1988

529 S Jackson St
Louisville, KY 40202
Phone (502) 562-4370

9931 Forest Green Blvd
Louisville, KY 40223
Phone (502) 588-0750

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

Organizations & group practices 3

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 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1588081749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 DUTCHMANS PKWY",
            "address_2": "STE 380",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053355",
            "telephone_number": "502-894-9753",
            "fax_number": "502-371-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 DUTCHMANS PKWY STE 380",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053355",
            "telephone_number": "502-894-8441",
            "fax_number": "502-894-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCKARDT",
        "first_name": "ELIZABETH",
        "middle_name": "SELF",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-26",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "53577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZBAETH",
            "last_name": "SELF",
            "middle_name": "MARY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.