COMMUNITY MEDICAL ASSOCIATES, INC.

Provider Demographics

• NPI: 1306983762
• Name: COMMUNITY MEDICAL ASSOCIATES, INC.
• Entity type: Organization
• Organization Name: COMMUNITY MEDICAL ASSOCIATES, INC.
• Authorized Official - Title/Position: VP MANAGED CARE
• Authorized Official - First Name: SHELLEY
• Authorized Official - Last Name: GAST
• Authorized Official - Phone: 502-588-9490
• Mailing Address - Street 1: PO BOX 776351
• Mailing Address - City: CHICAGO
• Mailing Address - State: IL
• Mailing Address - Zip Code: 60677-6351
• Mailing Address - Country: US
• Mailing Address - Phone: 502-588-9490
• Mailing Address - Fax: 502-272-5339
• Practice Address - Street 1: 4803 OLYMPIA PARK PLZ STE 1100
• Practice Address - City: LOUISVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 40241-3068
• Practice Address - Country: US
• Practice Address - Phone: 502-588-9490
• Practice Address - Fax: 502-272-5116
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-01
• Last Update Date: 2023-04-03

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	103G00000X	Behavioral Health & Social Service Providers	Clinical Neuropsychologist		Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Multi-Specialty
No	261QU0200X	Ambulatory Health Care Facilities	Clinic/Center	Urgent Care	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	1003882650	Medicaid
KY	65946279	Medicaid
KY	65945693	Medicaid
KY	65945693	Medicaid
KY	CC9492	Medicare PIN
IN	1003882650	Medicaid
KY	3619	Medicare PIN
IN	CD5379	Other	RAILROAD MEDICARE