NPIMap

Organization Active NPI

Norton Children'S Medical Group, LLC

  • Clinical Genetics (M.D.) Physician
  • Louisville, KY
National Provider Identifier
1770190167
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
Legal business name
NORTON CHILDREN'S MEDICAL GROUP, LLC
Practice address
4803 Olympia Park PLZ Ste 1100
Louisville, KY 40241-3068
Phone
(502) 272-5336
Fax
(502) 272-5339
NPI assigned
Sep 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Authorized official

Name
Shelley Gast
Title
Syst VP MNGD Care & Payor Strat
Phone
(502) 272-5335

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133V00000X
Metabolic Nutrition Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133VN1006X
Genetic Counselor (M.S.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 170300000X
Clinical Genetics (M.D.) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207SG0201X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X
Pediatric Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0200X

Addresses

Primary practice location

4803 Olympia Park PLZ Ste 1100
Louisville, KY 40241-3068

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 272-5336

Other names 1

  • Norton Children's Genetics Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200102000758 KY Part B Supplier - Clinic/Group Practice 3779917596 Receives reassigned benefits from 1,011 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory
Tax ID family
Norton Childrens Medical Group LLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641772800000",
    "number": "1770190167",
    "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": "606776879",
            "telephone_number": "502-272-5336",
            "fax_number": "502-272-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 OLYMPIA PARK PLZ STE 1100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402413068",
            "telephone_number": "502-272-5336",
            "fax_number": "502-272-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTON CHILDREN'S MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "GAST",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "SYST VP MNGD CARE & PAYOR STRAT",
        "authorized_official_telephone_number": "502-272-5335"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "170300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Norton Children's Genetics Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Norton Children's Genetics Center",
            "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 Jan 10, 2022; 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.