Active NPI
Sports Medicine Surgical Specialists PLLC
Doing business as Kentuckiana Foot and Ankle Sports Medicine
- Foot & Ankle Surgery Podiatrist
- Louisville, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- Legal business name
- SPORTS MEDICINE SURGICAL SPECIALISTS PLLC
- Doing business as
- Kentuckiana Foot and Ankle Sports Medicine
- Practice address
- 6400 Dutchmans Pkwy Ste 215
Louisville, KY 40205-3343 - Phone
- (502) 721-8288
- Fax
- (502) 721-8792
- NPI assigned
- Nov 5, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Keith Wellington Myrick, DPM
- Title
- Sole Owner
- Phone
- (502) 721-8288
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | Primary | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
6400 Dutchmans Pkwy Ste 215
Louisville, KY 40205-3343
Mailing address
6400 Dutchmans Pkwy
# 215
Louisville, KY 40205-3340
Phone (502) 721-8288
Other practice location 1
210 E Gray St Ste 820
Louisville, KY 40202-3900
Phone (502) 585-3668
Other practice location 2
200 Missouri Ave Ste A
Jeffersonville, IN 47130-3014
Phone (812) 920-0055
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100333220 | Medicaid | KY |
Other names 1
- Kentuckiana Foot and Ankle Sports Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY, IN
Enrollment records 2
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Kentuckiana Foot and Ankle Sports Medicine
- Durable Medical Equipment & Medical Supplies
- Louisville, KY
- NPI 1821651852
5597089367
-
- Durable Medical Equipment & Medical Supplies
- Louisville, KY
- NPI 1861357899
5597089367
National Provider Directory
National Provider DirectoryLocations
1263 Hospital Dr NW
Ste 105
Corydon, IN 47112
Phone (812) 734-3800
200 Missouri Ave
Ste A
Jeffersonvlle, IN 47130
Phone (502) 242-6370
4130 Dutchmans Ln
#215
Louisville, KY 40207
210 E Gray St
Ste 820
Louisville, KY 40202
Phone (502) 585-3668
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Foot & Ankle Surgery Podiatrist
- Louisville, KY
- NPI 1851731194
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415145600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1638662400000",
"number": "1689070559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6400 DUTCHMANS PKWY",
"address_2": "# 215",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402053340",
"telephone_number": "502-721-8288",
"fax_number": "502-721-8792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6400 DUTCHMANS PKWY STE 215",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402053343",
"telephone_number": "502-721-8288",
"fax_number": "502-721-8792"
}
],
"practiceLocations": [
{
"address_1": "210 E Gray St Ste 820",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402023900",
"country_code": "US",
"telephone_number": "502-585-3668",
"fax_number": "502-585-3662",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "200 Missouri Ave Ste A",
"address_purpose": "LOCATION",
"city": "Jeffersonville",
"state": "IN",
"postal_code": "471303014",
"country_code": "US",
"telephone_number": "812-920-0055",
"fax_number": "812-920-0060",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SPORTS MEDICINE SURGICAL SPECIALISTS PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-11-05",
"last_updated": "2021-12-05",
"certification_date": "2021-12-05",
"status": "A",
"authorized_official_last_name": "MYRICK",
"authorized_official_first_name": "KEITH",
"authorized_official_middle_name": "WELLINGTON",
"authorized_official_title_or_position": "SOLE OWNER",
"authorized_official_telephone_number": "502-721-8288",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100333220",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kentuckiana Foot and Ankle Sports Medicine",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kentuckiana Foot and Ankle Sports Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}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 Dec 5, 2021; 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.