NPIMap

Individual provider Active NPI

Amanda D Peach, APRN

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1679996565
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3008494 Issued in KY
Practice address
9510 Ormsby Station Rd Ste 100
Louisville, KY 40223-4082
Phone
(502) 327-9100
Fax
(855) 632-8329
NPI assigned
Jan 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3008494 KY Primary

Addresses

Primary practice location

9510 Ormsby Station Rd Ste 100
Louisville, KY 40223-4082

Mailing address

9510 Ormsby Station Rd Ste 100
Louisville, KY 40223-4082
Phone (502) 327-9100

Other identifiers 1

IdentifierTypeStateIssuer
12650284OtherCAQH

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
I20140311000608 KY Practitioner - Nurse Practitioner 1850521980 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Brooks Family Medical LLCGroup PAC ID 3577911569, 13 clinicians

Practice addresses (Care Compare)

2233 Lower Hunters Trce
Louisville, KY 40216-1358
Phone (502) 357-9211

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brooks Family Medical LLC Family CurrentSince May 6, 2024 Accepting new patients
Ky Pharmacy CurrentSince May 6, 2024 Accepting new patients
Southeastern Emergency Physicians LLC CurrentSince Mar 13, 2024 Accepting new patients
Amin's Family Practice Associates , PSC Family CurrentSince May 20, 2023 Accepting new patients

Locations

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

1505 S 7th St
Louisville, KY 40208
Phone (502) 637-1005

7926 Preston Hwy
Ste 103
Louisville, KY 40219
Phone (502) 309-9811

10100 Dixie Hwy
Louisville, KY 40272
Phone (502) 637-1005

2231 Lower Hunters Trce
Louisville, KY 40216
Phone (502) 719-0072

3920 Dutchmans Ln
Louisville, KY 40207
Phone (502) 259-6000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679996565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9510 ORMSBY STATION RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234082",
            "telephone_number": "502-327-9100",
            "fax_number": "855-632-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 ORMSBY STATION RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234082",
            "telephone_number": "502-327-9100",
            "fax_number": "855-632-8329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACH",
        "first_name": "AMANDA",
        "middle_name": "D",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3008494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12650284",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.