Dawn Balcom
Individual provider Active NPI Family Nurse Practitioner · Louisville, KY
NPI 1811366404 · NPPES record last updated Sep 24, 2015
Key facts
- NPI
- 1811366404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 30009692 (KY)
- Practice address
- 401 E Chestnut St Unit 310
Louisville, KY 40202-5703 - Phone
- (502) 588-4600
- NPI assigned
- Sep 24, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151118001479 | KY | Practitioner - Nurse Practitioner | 0648570978 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30009692 | KY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Louisville Physicians, Inc. | Current | Accepting new patients | |
| University of Louisville Research Foundation Inc | Family | Current | Accepting new patients |
| University of Louisville Research Foundation, Inc. | Current |
Accepting new patients | |
| University of Louisville Physicians, Inc. | Past | Accepting new patients |
Locations
550 S Jackson St
Louisville, KY 40202
Phone (502) 561-8686
401 E Chestnut St
Unit 310
Louisville, KY 40202
Phone (502) 584-8563
571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700
Interoperability endpoints
- dawnbalcom@uoflouisph.allscriptsdirect.net
- dbalcom17001@uoflhealth-dm.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 30009692 | KY | Yes |
Addresses
Primary practice location
401 E Chestnut St Unit 310
Louisville, KY 40202-5703
Mailing address
6610 Shelburn Dr
Crestwood, KY 40014-8945
Phone (502) 744-7439
Other providers in Louisville, KY
- Nicholas Brian Balash
- Shiva Balasubramanian
- Joselito T Balatbat
- Josue Raul Balbuena
- Stephanie McIntyre Balch
- Kenneth Lorne Balcombe
- Jacob Baldauf
- Takeysha Baldon
- Casey Eugene Baldwin
- Charla Baldwin
All providers in Louisville, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.