NPIMap

Organization Active NPI

Bluegrass Podiatric Management LLC

  • Podiatrist
  • Louisville, KY
National Provider Identifier
1720477672
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
BLUEGRASS PODIATRIC MANAGEMENT LLC
Practice address
9800 Shelbyville Rd Ste 202
Louisville, KY 40223-5440
Phone
(502) 536-7224
Fax
(888) 419-6943
NPI assigned
Jan 15, 2015
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Angie Lasorella
Title
Credentialing Supervisor
Phone
(513) 829-9333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Podiatrist 213E00000X Primary

Addresses

Primary practice location

9800 Shelbyville Rd Ste 202
Louisville, KY 40223-5440

Mailing address

178 N Ewing Ave
Louisville, KY 40206-2459
Phone (502) 554-3792

Other identifiers 1

IdentifierTypeStateIssuer
7100335760MedicaidKY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1720477672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 N EWING AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402062459",
            "telephone_number": "502-554-3792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 SHELBYVILLE RD STE 202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235440",
            "telephone_number": "502-536-7224",
            "fax_number": "888-419-6943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS PODIATRIC MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "LASORELLA",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "513-829-9333"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100335760",
            "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 Oct 29, 2024; 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.