NPIMap

Organization Active NPI

Cpo PSC

  • Pain Medicine Physician
  • Louisville, KY
National Provider Identifier
1720090525
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
31716 Issued in KY
Legal business name
CPO PSC
Practice address
4402 Churchman Ave
Suite 404
Louisville, KY 40215-1190
Phone
(502) 363-4156
NPI assigned
Aug 12, 2006
Last updated
May 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Authorized official

Name
Lawrence H Peters, MDNPI 1417927229
Title
MD
Phone
(502) 366-0970

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 31716 KY
Family Nurse Practitioner 363LF0000X 5222 KY
Pain Medicine Physician 208VP0000X 31716 KY Primary

Addresses

Primary practice location

4402 Churchman Ave
Suite 404
Louisville, KY 40215-1190

Mailing address

PO Box 30563
Belfast, ME 04915-2057
Phone (888) 488-8289

Other identifiers 2

IdentifierTypeStateIssuer
65900961MedicaidKY
78903531MedicaidKY

National Provider Directory

National Provider Directory

Locations

1900 Bluegrass Ave
#200
Louisville, KY 40215
Phone (502) 366-0970

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1720090525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30563",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152057",
            "telephone_number": "888-488-8289",
            "fax_number": "502-919-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 CHURCHMAN AVE",
            "address_2": "SUITE 404",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402151190",
            "telephone_number": "502-363-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CPO PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "502-366-0970",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "31716",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "5222",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": "31716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65900961",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78903531",
            "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 May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.