NPIMap

Organization Active NPI

Renaissance Medical LLC

  • Durable Medical Equipment & Medical Supplies
  • Louisville, KY
National Provider Identifier
1982606851
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
MG0190 Issued in KY
Legal business name
RENAISSANCE MEDICAL LLC
Practice address
4530 Bishop LN
Suite 100
Louisville, KY 40218-4561
Phone
(502) 961-8560
Fax
(606) 878-1862
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Authorized official

Name
Mr. James C Graham, RRT
Title
President
Phone
(606) 878-0453

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X HME00021 KY
Durable Medical Equipment & Medical Supplies 332B00000X MG0190 KY Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Oxygen Equipment & Supplies (DME) 332BX2000X

Addresses

Primary practice location

4530 Bishop LN
Suite 100
Louisville, KY 40218-4561

Mailing address

1380 W 5TH St
London, KY 40741-1615
Phone (606) 878-0453

Other identifiers 17

IdentifierTypeStateIssuer
164438OtherIN STATE DEPT HLTH CSH
S864OtherANTHEM
2196098OtherAETNA
040021100OtherFEDERAL BLACK LUNG PROGRA
119010OtherBCBS MI ABP PLAN
C82008OtherCHI
110110OtherAMERICAN BENEFIT PLAN
228579OtherGHP
006895400OtherUS DEPT OF LABOR
26404V2111OtherAHDS
7100165610MedicaidKY
C82003OtherCHI
000000070422OtherANTHEM
7100166520MedicaidKY
822271OtherBCBS PENN
1079739OtherKYPASSPORT
1171574OtherCUMBERLAND HEALTHCARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930010321 KY DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 3971624560 Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Renaissance Medical LLC4530 Bishop LN, Louisville, KY 40218-4561(502) 961-8560 Commodes, Urinals, Bedpans|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Walkers|Wheelchairs (Standard Manual)|Wheelchairs (Standard Manual Related Accessories)|Wheelchair Seating/Cushions|Tracheotomy Supplies|Continuous Positive Airway Pressure … Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Renaissance Medical LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

95 Bryan Blvd
Ste 101
Corbin, KY 40701
Phone (606) 526-1107

1006 Leawood Dr
Ste 201
Frankfort, KY 40601
Phone (502) 227-7422

4530 Bishop Ln
Ste 100
Louisville, KY 40218
Phone (502) 961-8560

3865 Produce Rd
Ste 207
Louisville, KY 40218
Phone (502) 961-8560

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591056000000",
    "number": "1982606851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 W 5TH ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411615",
            "telephone_number": "606-878-0453",
            "fax_number": "606-878-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 BISHOP LN",
            "address_2": "SUITE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402184561",
            "telephone_number": "502-961-8560",
            "fax_number": "606-878-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-878-0453",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RRT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "HME00021",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "MG0190",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN STATE DEPT HLTH CSH",
            "identifier": "164438",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "S864",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2196098",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG PROGRA",
            "identifier": "040021100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI ABP PLAN",
            "identifier": "119010",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHI",
            "identifier": "C82008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BENEFIT PLAN",
            "identifier": "110110",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "228579",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "006895400",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHDS",
            "identifier": "26404V2111",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100165610",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHI",
            "identifier": "C82003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000070422",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100166520",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PENN",
            "identifier": "822271",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1079739",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CUMBERLAND HEALTHCARE",
            "identifier": "1171574",
            "state": null
        }
    ],
    "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 Jun 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.