Louisville Dermatology ASC PSC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LOUISVILLE DERMATOLOGY ASC PSC

Practice address

1700 Bluegrass Avenue
Suite 300
Louisville, KY 40215

Phone

(502) 363-1841

Fax

(502) 366-3317

NPI assigned

Jan 2, 2007

Last updated

Dec 2, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Martin Thomas Logsdon, MDNPI 1538110424

Title

Dermatologist Owner

Phone

(502) 363-1841

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 7

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.

• Martin Thomas Logsdon, MD

  • Dermatology Physician
  • Louisville, KY
  • NPI 1538110424
  Medicare reassignment NPD Authorized official
• Christy Quire Baker, FNP-BC

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1780671651
  NPD
• Denise Thompson Dickinson, M.D.

  • Dermatology Physician
  • Louisville, KY
  • NPI 1831267459
  NPD (past)
• Michelle H Hannigan, APRN

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1518983188
  NPD (past)
• Patricia C Mader, A.R.N.P.

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1285639005
  NPD (past)
• Heather J Mucci, ARNP

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1518916329

  Dermatology

  NPD (past)
• Ermina Mujadzic, MD

  • Family Medicine Physician
  • Evans, GA
  • NPI 1588790794

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385942400000",
    "number": "1669539789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 BLUEGRASS AVENUE",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-363-1841",
            "fax_number": "502-366-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 BLUEGRASS AVENUE",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-363-1841",
            "fax_number": "502-366-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISVILLE DERMATOLOGY ASC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2013-12-02",
        "status": "A",
        "authorized_official_last_name": "LOGSDON",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "DERMATOLOGIST OWNER",
        "authorized_official_telephone_number": "502-363-1841",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50005707",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943797",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Louisville Emergency Medicine Associates
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• Dermatology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Dermatology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.