NPIMap

Individual provider Active NPI

Juan Gustavo Polo, MD

  • Internal Medicine Physician
  • Louisville, KY
National Provider Identifier
1952399669
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36067 Issued in KY
Practice address
234 E Gray St
Ste. 670
Louisville, KY 40202-1900
Phone
(502) 629-4525
Fax
(502) 629-4529
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36067 KY Primary

Addresses

Primary practice location

234 E Gray St
Ste. 670
Louisville, KY 40202-1900

Mailing address

234 E Gray St
Ste. 670
Louisville, KY 40202-1900
Phone (502) 629-4525

Other identifiers 13

IdentifierTypeStateIssuer
200489040OtherINANTHEM INDIANA MEDICAID- NORTON ICC
64017098MedicaidKY
200489040MedicaidIN
200489040OtherKYMD WISE- NORTON ICC
1128117OtherKYPASSPORT
200489040OtherKYHEALTHY INDIANA PLAN- NORTON ICC
31K4, 000000179689OtherKYANTHEM
P00838101OtherINRRMCR - NICC
002045573-002OtherUNITED HEALTHCARE
017376OtherKYSIHO - NORTON ICC
5832707OtherKYAETNA
P00362331OtherKYRRMCR - NICC
000000381954OtherKYANTHEM - NORTON ICC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041101001053 KY Practitioner - Family Practice 1254393283 Reassigns benefits to 1 organization
I20060207000838 IN Practitioner - Internal Medicine 1254393283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

7926 Preston Hwy
Suite 106
Louisville, KY 40219-3848
Phone (502) 964-4357

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Internal Medicine CurrentSince Jan 1, 2006 Accepting new patients
Community Medical Associates, Inc. Internal Medicine Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2006 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 14, 2014 Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients
Norton Enterprises, Inc. Past Accepting new patients
Internal Medicine Consultants, PLLC Past Accepting new patients

Locations

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

1373 E State Road 62
#6F
Madison, IN 47250
Phone (502) 629-7181

3101 Poplar Level Rd
Ste 101
Louisville, KY 40213
Phone (502) 636-7444

2355 Poplar Level Rd
Ste 200
Louisville, KY 40217
Phone (502) 365-2655

7926 Preston Hwy
Louisville, KY 40219
Phone (502) 964-4357

7926 Preston Hwy
Ste 106
Louisville, KY 40219
Phone (502) 964-4357

10284 Shelbyville Rd
Louisville, KY 40223
Phone (502) 244-5827

1102 Lyndon Ln
Louisville, KY 40222
Phone (502) 423-7911

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

7926 Preston Hwy
Ste 103
Louisville, KY 40219
Phone (502) 309-9811

Interoperability endpoints

  • Direct secure messaging: jpolo11805@direct.nortonhealthcare.org

Organizations & group practices 7

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1952399669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 E GRAY ST",
            "address_2": "STE. 670",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021900",
            "telephone_number": "502-629-4525",
            "fax_number": "502-629-4529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E GRAY ST",
            "address_2": "STE. 670",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021900",
            "telephone_number": "502-629-4525",
            "fax_number": "502-629-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLO",
        "first_name": "JUAN",
        "middle_name": "GUSTAVO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "36067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM INDIANA MEDICAID- NORTON ICC",
            "identifier": "200489040",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64017098",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200489040",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD WISE- NORTON ICC",
            "identifier": "200489040",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1128117",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY INDIANA PLAN- NORTON ICC",
            "identifier": "200489040",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "31K4, 000000179689",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR - NICC",
            "identifier": "P00838101",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "002045573-002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO - NORTON ICC",
            "identifier": "017376",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5832707",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR - NICC",
            "identifier": "P00362331",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM - NORTON ICC",
            "identifier": "000000381954",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.