Marcus A Gibson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

7305 Issued in KY

Practice address

2215 Portland Ave
Louisville, KY 40212-1033

Phone

(502) 774-8631

Fax

(502) 772-8189

NPI assigned

Mar 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1649732603
  Medicare reassignment NPD
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1104879469
  NPD
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1205689064
  NPD
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1205889540
  NPD
• Family Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1942954441
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1134172489
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1356394670
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1427574862
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1518963230
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
  • NPI 1578774477
  NPD (past)
• Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fairdale, KY
  • NPI 1871546119
  NPD (past)

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1811029010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950244",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950244",
            "telephone_number": "502-953-4700",
            "fax_number": "502-772-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 PORTLAND AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402121033",
            "telephone_number": "502-774-8631",
            "fax_number": "502-772-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARCUS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "7305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100174040",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elayna Brooke Gibson, PA-C
• Gracie Noel Gibson I
• Joy Gibson
• Madison Gibson, OD
• Makenna Brianne Gibson, DMD
• Melissa Ann Gibson, PSYD
• Richard Gibson, M.D.
• Tammy Charlyn Gibson, RPH DPH
• William Tyler Gibson, OD
• Erin Lorena Gick, OTD, OTR

• Dentist in Louisville, KY
• Providers in Louisville, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.