PEARL MEDICAL PRACTICE PLLC (NPI# 1114261203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114261203 |
| Entity Type | Organization |
| Organization Name | PEARL MEDICAL PRACTICE PLLC |
| Practice Address |
4200 Gardiner View Ave Suite 200 Louisville KY 40213-1877 |
| Practice Telephone | 5024560494 |
| Practice Fax Number | 5024560496 |
| Mailing Telephone | 5024560494 |
| Mailing Fax Number | 5024560496 |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-10-02 |
| Authorized Official Name | OSAWARU OMORUYI (PRESIDENT) |
| Authorized Official Telephone | 5024560494 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100267920 | 05 | |
| KY | 7100259660 | 05 |
| Street Address |
4200 GARDINER VIEW AVE SUITE 200 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40213-1877 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316310725 | Oluwasegun A Abe | Nurse Practitioner | 4200 Gardiner View Ave, #200, Louisville, KY 40213-1877 | 2015-11-06 |
| 1407226970 | Deanna Renee Gordinier | Nurse Practitioner | 4200 Gardiner View Ave, Suite 101, Louisville, KY 40213-1877 | 2015-09-28 |
| 1669841631 | Pearl Medical Care Center | Clinical Nurse Specialist | 4200 Gardiner View Ave, Suite 101, Louisville, KY 40213-1877 | 2015-09-21 |
| 1174912406 | Gina Clark | Nurse Practitioner | 4200 Gardiner View Ave, Louisville, KY 40213-1877 | 2015-01-09 |
| 1053716803 | Kara King | Nurse Practitioner | 4200 Gardiner View Ave, Suite 101, Louisville, KY 40213-1877 | 2014-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487130076 | Latonia Cheeks | Counselor | 4835 Poplar Level Rd Ste. 110, Louisville, KY 40213 | 2018-07-17 |
| 1225553431 | Kandace Ratterman | Case Manager/Care Coordinator | 4814 Kingfisher Way, Louisville, KY 40213 | 2017-08-08 |
| 1700338456 | Ann Devos | Physician Assistant | 3303 Fern Valley Road, Louisville, KY 40213 | 2016-10-28 |
| 1124426275 | Rebecca Sue Jenkins | Home Health Aide | 3523 Whippoorwill Rd, Louisville, KY 40213 | 2014-12-05 |
| 1053518308 | Gabor Ambrus | Pathology | 4500 Conaem Drive, Louisville, KY 40213 | 2007-06-29 |
| 1760504724 | Benjamin Francis Robinson | Chiropractor | 4919h Dixie Highway, Louisville, KY 40213 | 2007-04-03 |
| 1790814408 | Howard L Green | Dentist | 3813 Poplar Level Rd, Louisville, KY 40213 | 2007-03-06 |
| 1063587970 | Roy Hyman | Optometrist | 5202 Preston Hwy, Louisville, KY 40213 | 2006-11-24 |
| 1689769291 | James H Kidwell | Psychologist | 1448 Gardiner Lane, Suite 202 203, Louisville, KY 40213 | 2006-10-03 |
| 1366556524 | Harris & Harris Dmd Psc | Dentist | 5014 Preston Hwy, #b, Louisville, KY 40213 | 2006-08-17 |
| Find all providers in zip 40213 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679192611 | Temple Triage Pllc | Clinic/Center | 8209 Pennsylvania Run Rd, Louisville, KY 40228-2143 | 2020-04-09 |
| 1700323987 | Mills Medical Practices, LLC | Clinic/Center | 805 N Whittington Pkwy, Louisville, KY 40222-5186 | 2017-01-25 |
| 1801029822 | Southeast Alabama Regional Healthcare Authority | Clinic/Center | 31 Railroad Street, Louisville, AL 36048 | 2009-08-25 |
| 1538364716 | East Tennessee Children's Hospital Primary Care Center, Inc. | Clinic/Center | 1921 Topside Road, Louisville, TN 37777 | 2007-06-18 |
| 1962562884 | Ar Medical LLC | Clinic/Center | 809 Peachtree Street, Louisville, GA 30434-1449 | 2006-12-11 |
| 1831120401 | County of Clay | Clinic/Center | 935 Bryant St, Louisville, IL 62858-1053 | 2006-07-05 |
| 1427677160 | Louisville Family Care, Pllc | Clinic/Center | 6610 Bardstown Rd, Louisville, KY 40291-3045 | 2020-04-13 |
| 1336512680 | Sondra Kathleen Adkins | Clinic/Center | 4950 Norton Healthcare Blvd, Ste 305, Louisville, KY 40241-2845 | 2015-11-09 |
| 1265844781 | Convenient Care Family Medical | Clinic/Center | 11302 Preston Hwy, Suite 2, Louisville, KY 40229-2862 | 2014-06-02 |
| 1992122972 | Kaplan, Barron, Roth, Lehocky & Katz Psc | Clinic/Center | 3333 Bardstown Rd, Louisville, KY 40218-4613 | 2014-03-27 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40213 |
Please comment or provide details below to improve the information on PEARL MEDICAL PRACTICE PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.