NPIMap

Organization Active NPI

Louisville Behavioral Health Systems PLLC

  • Psychiatry Physician
  • Louisville, KY
National Provider Identifier
1619088549
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LOUISVILLE BEHAVIORAL HEALTH SYSTEMS PLLC
Practice address
3430 Newburg Rd
Suite 210
Louisville, KY 40218-2497
Phone
(502) 454-8800
Fax
(502) 736-0140
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Ms. Evelyn Rose Zwanzig
Title
Credentialing Specialist
Phone
(502) 454-8800

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

3430 Newburg Rd
Suite 210
Louisville, KY 40218-2497

Mailing address

3430 Newburg Rd
Suite 210
Louisville, KY 40218-2497
Phone (502) 454-8800

Other identifiers 2

IdentifierTypeStateIssuer
7100152610MedicaidKY
7100041560MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000117 KY Part B Supplier - Clinic/Group Practice 1759378946 Receives reassigned benefits from 19 practitioners
Practice locations: Louisville, KY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2102748Louisville Behavioral Health Systems PLLC3430 Newburg Rd Ste 210, Louisville, KY 40218Certificate of waiverSep 28, 2027

National Provider Directory

National Provider Directory

Locations

3430 Newburg Rd
Ste 210
Louisville, KY 40218
Phone (502) 225-4900

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1619088549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 NEWBURG RD",
            "address_2": "SUITE 210",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182497",
            "telephone_number": "502-454-8800",
            "fax_number": "502-736-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 NEWBURG RD",
            "address_2": "SUITE 210",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182497",
            "telephone_number": "502-454-8800",
            "fax_number": "502-736-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISVILLE BEHAVIORAL HEALTH SYSTEMS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "ZWANZIG",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "502-454-8800",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100152610",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100041560",
            "state": "KY"
        }
    ],
    "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 Jul 22, 2021; 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.