Individual provider Active NPI

Ankur Datta, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Louisville, KY
National Provider Identifier
1750553665
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
58279 Issued in KY
Practice address
4123 Dutchmans LN Ste 606
Louisville, KY 40207-4725
Phone
(502) 896-2500
NPI assigned
Mar 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 036.128019 IL
Neonatal-Perinatal Medicine Physician 2080N0001X 58279 KY Primary

Addresses

Primary practice location

4123 Dutchmans LN Ste 606
Louisville, KY 40207-4725

Mailing address

PO Box 776879
Chicago, IL 60677-2991
Phone (502) 588-9490

Other identifiers 1

IdentifierTypeStateIssuer
036.128019MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, KY, IN3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180925003932 IL Practitioner - Pediatric Medicine 9234358425 Reassigns benefits to 1 organization
I20231109003260 KY Practitioner - Pediatric Medicine 9234358425 Reassigns benefits to 1 organization
I20240304001336 IN Practitioner - Pediatric Medicine 9234358425 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.128019ILMDNeonatal-Perinatal Medicine Physician
58279KYMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lurie Children'S Medical Group Inc CurrentSince Aug 8, 2018 Accepting new patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Norton Children'S Medical Group, LLC Neonatal-Perinatal Medicine CurrentSince Oct 1, 2023 Accepting new patients
Norton Childrens Medical Group, LLC Neonatal-Perinatal Medicine Current Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Oct 1, 2023 Accepting new patients
Norton Hospitals, Inc Past Accepting new patients

Locations

Claims Remittance
Carol Stream, IL 60122

225 E Chicago Ave
Chicago, IL 60611
Phone (312) 227-6415

737 N Michigan Ave
Ste 2040
Chicago, IL 60611

2051 Clevidence Blvd
Ste C
Clarksville, IN 47129
Phone (812) 280-6623

2051 Clevidence Blvd
Ste B
Clarksville, IN 47129
Phone (502) 629-2030

1220 Missouri Ave
Jeffersonvlle, IN 47130
Phone (812) 282-2072

411 E Chestnut St
#2
Louisville, KY 40202
Phone (502) 588-0902

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

4123 Dutchmans Ln
Ste 606
Louisville, KY 40207
Phone (502) 896-2500

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

1000 Breckenridge St
Ste 301
Owensboro, KY 42303
Phone (270) 852-8894

Interoperability endpoints

  • Direct secure messaging: adatta276558@direct.nortonhealthcare.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1750553665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606772991",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 DUTCHMANS LN STE 606",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074725",
            "telephone_number": "502-896-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTA",
        "first_name": "ANKUR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-31",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036.128019",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "KY",
            "license": "58279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036.128019",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.