NPIMap

Organization Active NPI

Radiant

  • General Practice Physician
  • Louisville, KY
National Provider Identifier
1831555143
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
22964 Issued in KY
Legal business name
RADIANT
Practice address
2301 Terra Crossing Blvd
Ste 103
Louisville, KY 40245-4994
Phone
(304) 687-4204
NPI assigned
Jan 4, 2016
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Ms. Tiffany Smith, PA-CNPI 1154576981
Title
President
Phone
(304) 687-4204

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1075 KY
Family Nurse Practitioner 363LF0000X 3007017 KY
General Practice Physician 208D00000X 22964 KY Primary

Addresses

Primary practice location

2301 Terra Crossing Blvd
Ste 103
Louisville, KY 40245-4994

Mailing address

2301 Terra Crossing Blvd Ste 103
Louisville, KY 40245-3909
Phone (502) 410-0191

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161121002292 KY Part B Supplier - Clinic/Group Practice 8426337122 Receives reassigned benefits from 9 practitioners
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Locations

2301 Terra Crossing Blvd
Ste 103
Louisville, KY 40245
Phone (502) 410-0191

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1831555143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 TERRA CROSSING BLVD STE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402453909",
            "telephone_number": "502-410-0191",
            "fax_number": "502-890-5177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 TERRA CROSSING BLVD",
            "address_2": "STE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402454994",
            "telephone_number": "304-687-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-04",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-687-4204",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1075",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3007017",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KY",
            "license": "22964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 3, 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.