NPIMap

Organization Active NPI

Nephrology Associates of Kentuckiana PSC

  • Nephrology Physician
  • Louisville, KY
National Provider Identifier
1730161753
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NEPHROLOGY ASSOCIATES OF KENTUCKIANA PSC
Practice address
6400 Dutchmans Pkwy
Suite 250
Louisville, KY 40205-3354
Phone
(502) 587-9660
Fax
(502) 540-5615
NPI assigned
Nov 16, 2005
Last updated
Aug 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Ms. Debra Lynn Roos, CPC
Title
Billing Office Manager
Phone
(502) 587-9660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

6400 Dutchmans Pkwy
Suite 250
Louisville, KY 40205-3354

Mailing address

6400 Dutchmans Pkwy
Suite 250
Louisville, KY 40205-3354
Phone (502) 587-9660

Other identifiers 6

IdentifierTypeStateIssuer
100076180AMedicaidIN
3800OtherKYANTHEM GROUP NUMBER
7100237180MedicaidKY
163655200OtherKYDEPT OF LABOR GROUP #
1050694MedicaidKY
65905416MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000650 IN Part B Supplier - Clinic/Group Practice 4183522618 Receives reassigned benefits from 34 practitioners
Practice locations: Scottsburg, IN; Salem, IN; New Albany, IN; Jeffersonville, IN; Corydon, IN; Clarksville, IN; Madison, IN
O20040204000026 KY Part B Supplier - Clinic/Group Practice 4183522618 Receives reassigned benefits from 60 practitioners
Practice locations: Louisville, KY; Frankfort, KY; Munfordville, KY; Richmond, KY; Shephardville, KY; Shepherdsville, KY; Lexington, KY; Lebanon, KY…

National Provider Directory

National Provider Directory

Locations

1919 State St
Ste 444
New Albany, IN 47150
Phone (502) 368-9590

349 Broadway St
Brandenburg, KY 40108
Phone (270) 422-1269

914 N Dixie Ave
Ste 303
Elizabethtown, KY 42701
Phone (270) 900-0871

210 Burley Ave
Ste A
Hopkinsville, KY 42240
Phone (270) 885-6353

100 W Market St
#2
Louisville, KY 40202
Phone 5025879660239

2400 Eastpoint Pkwy
Ste 560
Louisville, KY 40223
Phone (502) 210-6610

4002 Kresge Way
Ste 122
Louisville, KY 40207

4500 Churchman Ave
Louisville, KY 40215
Phone (502) 361-1389

9880 Angies Way
Ste 130
Louisville, KY 40241
Phone (502) 365-2655

1036 Center Dr
Ste A
Richmond, KY 40475
Phone (859) 353-4245

115 Huston Dr
Ste 7
Shepherdsville, KY 40165

Practitioners & affiliated clinicians

Practitioners 75

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.

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1730161753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053354",
            "telephone_number": "502-587-9660",
            "fax_number": "502-540-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 DUTCHMANS PKWY",
            "address_2": "SUITE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402053354",
            "telephone_number": "502-587-9660",
            "fax_number": "502-540-5615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEPHROLOGY ASSOCIATES OF KENTUCKIANA PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "ROOS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING OFFICE MANAGER",
        "authorized_official_telephone_number": "502-587-9660",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100076180A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP NUMBER",
            "identifier": "3800",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100237180",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR GROUP #",
            "identifier": "163655200",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1050694",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65905416",
            "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 Aug 16, 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.

Verify at the official NPI Registry.