PEARL MEDICAL PRACTICE PLLC
NPI 1114261203
Clinic/Center - Primary Care in Louisville, KY

Active since November 15, 2012CLIA 18D2085247 · Accreditation
4200 GARDINER VIEW AVE, SUITE 200, LOUISVILLE, KY 40213(502) 456-0494(502) 456-0496 Get Directions Write a Review

NPPES record last updated: October 2, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Pearl Medical Practice Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEARL MEDICAL PRACTICE PLLC (NPI 1114261203) is a healthcare organization registered as a primary care in Louisville, Kentucky and active in the NPI registry since November 2012. The organization holds an CLIA Accreditation certificate valid through December 10, 2027 and lists Osawaru Omoruyi, President, as its authorized official.

NPPES Registry Identity

NPI1114261203
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NamePEARL MEDICAL PRACTICE PLLC
Location Address4200 GARDINER VIEW AVE, SUITE 200Louisville, KY 40213-1877
Mailing Address4200 Gardiner View Ave, Suite 200Louisville, KY 40213-1877 · (502) 456-0494 · Fax (502) 456-0496
Fax(502) 456-0496
Organization SubpartNo
Authorized OfficialOsawaru OmoruyiPresident · (502) 456-0494
Enumeration DateNovember 15, 2012
Last NPPES UpdateOctober 2, 2015
NPI 1114261203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Also ListedFamily Medicine · Geriatric MedicineTaxonomy 207QG0300X
Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
4200 GARDINER VIEW AVE, Louisville, KY 40213

Other Identifiers 3

Medicaid7100259660KY
Medicare PINK080050KY
Medicaid7100267920KY

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 18D2085247

Pearl Medical Practice, PLLC · Louisville, KY
Active · expires Dec 10, 2027
CLIA Number18D2085247
Laboratory TypePhysician Office
Certificate Effective DateDecember 11, 2025
Certificate Expiration DateDecember 10, 2027
Laboratory DirectorDr. Lewis Jackson
Laboratory Phone(502) 456-0494
Laboratory LocationPearl Medical Practice, PLLC2202 Buechel Ave, Louisville, KY 40218
CLIA data matches this NPI record on: Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
4200 GARDINER VIEW AVE, SUITE 101
LOUISVILLE, KY 40213
Nurse Practitioner (Primary Care)
4200 GARDINER VIEW AVE
LOUISVILLE, KY 40213
Nurse Practitioner (Family)
4200 GARDINER VIEW AVE, SUITE 101
LOUISVILLE, KY 40213

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pearl Medical Practice PLLC's NPI number?

The NPI number for Pearl Medical Practice PLLC is 1114261203. It was assigned to this organization in the NPPES registry on November 15, 2012.

Where is Pearl Medical Practice PLLC located?

Pearl Medical Practice PLLC is located at 4200 Gardiner View Ave Suite 200, Louisville, KY 40213. The listed phone number is (502) 456-0494.

What is Pearl Medical Practice PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Pearl Medical Practice PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 18D2085247) is associated with this NPI, valid through December 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pearl Medical Practice PLLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter of Tennessee and Blue Cross and Blue Shield of Texas and 1 other insurer list Pearl Medical Practice PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Pearl Medical Practice PLLC was last updated on October 2, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.