Individual provider Active NPI

Judith Ann Theriot, MD

  • Pediatrics Physician
  • Louisville, KY
National Provider Identifier
1811990476
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
31361 Issued in KY
Practice address
411 E Chestnut St # Street1
Louisville, KY 40202-1713
Phone
(502) 588-3440
Fax
(502) 588-3441
NPI assigned
May 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 31361 KY Primary

Addresses

Primary practice location

411 E Chestnut St # Street1
Louisville, KY 40202-1713

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other identifiers 1

IdentifierTypeStateIssuer
6431361200MedicaidKY

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jtheriot179399@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110525000452 KY Practitioner - Pediatric Medicine 7315123452 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31361KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC CurrentSince Mar 1, 2020 Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics CurrentSince Mar 1, 2020 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 1, 2012 Accepting new patients
Norton Children'S Medical Group, LLC Current Accepting new patients
University of Louisville Physicians, Inc. Pediatrics Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 1, 2012 Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

411 E Chestnut St
#1
Louisville, KY 40202
Phone (502) 588-3440

555 S Floyd St
Louisville, KY 40202
Phone (502) 588-3440

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

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

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1811990476",
    "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": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E CHESTNUT ST # STREET1",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021713",
            "telephone_number": "502-588-3440",
            "fax_number": "502-588-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIOT",
        "first_name": "JUDITH",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "31361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6431361200",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtheriot179399@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "411 E Chestnut St # Street1",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402021713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "411 E Chestnut St # Street1",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402021713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.