Park Duvalle Community Health Center, Inc. - Medicare Primary Care in Louisville, KY

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Park Duvalle Community Health Center, Inc. is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Louisville, Kentucky. The current practice location for Park Duvalle Community Health Center, Inc. is 1425 W. Broadway, Louisville, Kentucky. For appointments, you can reach them via phone at (502) 584-2992. The mailing address for Park Duvalle Community Health Center, Inc. is 3015 Wilson Ave, Louisville, Kentucky and phone number is (502) 774-4401.

Park Duvalle Community Health Center, Inc. is licensed to practice in Kentucky (license number 700005). The clinic also participates in the medicare program and its NPI number is 1255354361. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (502) 584-2992.

Contact Information

Park Duvalle Community Health Center, Inc.
1425 W. Broadway
Louisville
KY 40202
(502) 584-2992
(502) 584-3715

Map and Direction


Primary Care Clinic Profile

Full NamePark Duvalle Community Health Center, Inc.
SpecialityClinic/Center
Location1425 W. Broadway, Louisville, Kentucky
Authorized Official Name and PositionSwannie Jett (CEO)
Authorized Official Contact5027744401
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Park Duvalle Community Health Center, Inc.
3015 Wilson Ave
Louisville
KY 40211-1969

Ph: (502) 774-4401		Park Duvalle Community Health Center, Inc.
1425 W. Broadway
Louisville
KY 40202

Ph: (502) 584-2992

NPI Details:

NPI Number1255354361
Provider Enumeration Date07/26/2006
Last Update Date11/02/2021

Medicare PECOS Information:

Medicare PECOS PAC ID1658268974
Medicare Enrollment IDO20040302000539

Medical Identifiers

Medical identifiers for Park Duvalle Community Health Center, Inc. such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1255354361NPI-NPPES
31000011MedicaidKY

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) 700005 (Kentucky)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Park Duvalle Community Health Center, Inc. acts as a billing entity for following providers:
Provider NameJessica Dowe
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1265497499
PECOS PAC ID: 6103711973
Enrollment ID: I20040219000699
Provider NameSharon S Jamison
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1104815141
PECOS PAC ID: 7012807282
Enrollment ID: I20040319000537
Provider NameGiavonne D Rondo Hillman
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1124083514
PECOS PAC ID: 8729050976
Enrollment ID: I20050427000874
Provider NameRomeo S Ambrosio
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1194847871
PECOS PAC ID: 0143314633
Enrollment ID: I20070914000034
Provider NameLisa G Glass
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1275534091
PECOS PAC ID: 2264511229
Enrollment ID: I20080502000330
Provider NameJose T Lorenzo
Provider TypePractitioner - General Practice
Provider IdentifiersNPI Number: 1154434884
PECOS PAC ID: 0143388637
Enrollment ID: I20081028000484
Provider NameFe N Briones
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1598838294
PECOS PAC ID: 4082779277
Enrollment ID: I20090224000009
Provider NameDejuana N Frazier
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1285964551
PECOS PAC ID: 1254510043
Enrollment ID: I20110126000194
Provider NameCicely M Hamilton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710237532
PECOS PAC ID: 2062662919
Enrollment ID: I20121030000475
Provider NameLaretta V Dodson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1932531357
PECOS PAC ID: 0446493043
Enrollment ID: I20130829000735
Provider NameLecresha Y Sewell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1093107781
PECOS PAC ID: 6002133006
Enrollment ID: I20150401001835
Provider NameAmber Jainia Wood
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1538616578
PECOS PAC ID: 7416244884
Enrollment ID: I20160928002387
Provider NameMelissa Hines
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1801343140
PECOS PAC ID: 3375830565
Enrollment ID: I20161003002450
Provider NameKelly A Jedlicki
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1528155314
PECOS PAC ID: 5597042598
Enrollment ID: I20170428002097
Provider NameMiasha Renee Crutchfield
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1003344854
PECOS PAC ID: 0244501906
Enrollment ID: I20180209002156
Provider NameRayna L Nelson
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1902196918
PECOS PAC ID: 5597028639
Enrollment ID: I20180424001519
Provider NameJanneve Sankawulo
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356954366
PECOS PAC ID: 3173941556
Enrollment ID: I20200916003110
Provider NameDomini A Williams
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1982211405
PECOS PAC ID: 6608286695
Enrollment ID: I20201103000610
Provider NameYazmine Jaquez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1083215362
PECOS PAC ID: 5092126342
Enrollment ID: I20201118001184
Provider NameAdam Mitchell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881298727
PECOS PAC ID: 6507279148
Enrollment ID: I20201229000372
Provider NameMeaghen Lee Rodriguez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1437739166
PECOS PAC ID: 3678982444
Enrollment ID: I20210506002487
Provider NamePhoebe Morkos Girgis
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1538731484
PECOS PAC ID: 7012304082
Enrollment ID: I20220420003092
Provider NameAlice Boos-edwards
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144853029
PECOS PAC ID: 8123406576
Enrollment ID: I20220526000455
Provider NameMargo Renee Steed
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1760103915
PECOS PAC ID: 3870979339
Enrollment ID: I20221006001469
Provider NameLeandro Ernesto Hernandez Diaz
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376279711
PECOS PAC ID: 9335515634
Enrollment ID: I20221011001883
Provider NameDyna Fay Zehnder
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1992366199
PECOS PAC ID: 8426424789
Enrollment ID: I20221012001696
Provider NameRyan Hopson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1316655079
PECOS PAC ID: 9436527454
Enrollment ID: I20221123001545
Provider NameJennifer Estes
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1841909272
PECOS PAC ID: 1254700438
Enrollment ID: I20221209001642
Provider NameSara Alice Exton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710691902
PECOS PAC ID: 1254702301
Enrollment ID: I20230127000734
Provider NameElizabeth Zarantonello
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1730674045
PECOS PAC ID: 5597016790
Enrollment ID: I20230201003208
Provider NameKatelyn L Thompson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1629755749
PECOS PAC ID: 0648630699
Enrollment ID: I20230721001956
Provider NameMadelys Hernandez Urquiaga
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1689395642
PECOS PAC ID: 8224491550
Enrollment ID: I20230901003260
Provider NameVicki Larue
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1932158516
PECOS PAC ID: 2163526567
Enrollment ID: I20230907002547
Provider NameLakeshia K Blanton
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1154000230
PECOS PAC ID: 2961865282
Enrollment ID: I20230912003754
Provider NameAlyson Estes
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1992563951
PECOS PAC ID: 8820436512
Enrollment ID: I20240401000836
Provider NameErin Dunagan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1154187037
PECOS PAC ID: 1355780917
Enrollment ID: I20240415003581
Provider NameAngela Michelle Woodford
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1639953565
PECOS PAC ID: 0143550772
Enrollment ID: I20240513003446
Provider NameKiara Farris
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1083470975
PECOS PAC ID: 6305287590
Enrollment ID: I20240520001061
Provider NameTashana Ford
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1073350153
PECOS PAC ID: 2163962481
Enrollment ID: I20240912002141
Provider NameJessica Lewis
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1164269502
PECOS PAC ID: 2062953771
Enrollment ID: I20240923000329
Provider NameBayley Brutscher
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1821824798
PECOS PAC ID: 5698207231
Enrollment ID: I20241021001594
Provider NameOscar Arrate Fernandez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356161624
PECOS PAC ID: 5193252732
Enrollment ID: I20241220002486
Provider NameGabriela Grau Apa
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1871300608
PECOS PAC ID: 8628505815
Enrollment ID: I20241230002781
Provider NameRebecca Ellen Barnes
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1285437301
PECOS PAC ID: 8729502547
Enrollment ID: I20250414000995
Provider NameTawney Sweeney
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1649067604
PECOS PAC ID: 5294252961
Enrollment ID: I20250506002399
Provider NameRaul P Ibanez Hernandez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1699571083
PECOS PAC ID: 8022535491
Enrollment ID: I20250508002155

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.