Provider Demographics
NPI:1720127913
Name:LEWIS, JASON CARNES (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CARNES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-907-0356
Practice Address - Street 1:222 S 1ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5404
Practice Address - Country:US
Practice Address - Phone:502-855-3919
Practice Address - Fax:502-855-3920
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42621208VP0014X, 207LP2900X, 207L00000X
IN01072411A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000825810OtherANTHEM PROVIDER ID NUMBER
9497399OtherAETNA PIN NUMBER
KY7100080620Medicaid
KY84129KYIPOtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
KY961015OtherWELLCARE OF KY PROVIDER ID NUMBER
005625439OtherUNITED HEALTHCARE PROVIDER ID NUMBER
IN200955190Medicaid
CS1425100206OtherCARESOURCE PROVIDER ID NUMBER