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KENTUCKY MEDICAL SPECIALISTS, PSC
NPI 1295090884
Internal Medicine in Louisville, KY

Active since July 10, 2012CLIA 18D1008432 · Waiver
4001 KRESGE WAY STE # 236, LOUISVILLE, KY 40207(502) 893-7372(502) 409-4715 Get Directions Write a Review

NPPES record last updated: May 1, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 1, 2019, Apr 5, 2019, May 1, 2018 (3 updates tracked since 2018).

About Kentucky Medical Specialists, Psc NPPES

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

KENTUCKY MEDICAL SPECIALISTS, PSC (NPI 1295090884) is a healthcare organization registered as an internal medicine in Louisville, Kentucky and active in the NPI registry since July 2012. The organization holds a CLIA Waiver certificate valid through May 25, 2028 and lists Marlon R Chagua, President, as its authorized official.

NPPES Registry Identity

NPI1295090884
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameKENTUCKY MEDICAL SPECIALISTS, PSC
Location Address4001 KRESGE WAY STE # 236Louisville, KY 40207
Mailing Address4001 Kresge Way Ste # 236Louisville, KY 40207 · (502) 893-7372 · Fax (502) 409-4715
Phone(502) 893-7372
Fax(502) 409-4715
Organization SubpartNo
Authorized OfficialMarlon R ChaguaPresident · (502) 893-7372
Enumeration DateJuly 10, 2012
Last NPPES UpdateMay 1, 20193 updates tracked since enumeration
✔ NPI 1295090884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in KY · 36325
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X
4001 KRESGE WAY STE # 236, Louisville, KY 40207
Open in Google Maps ↗

Other Identifiers 2

Medicaid64063266KY
Medicaid7100235310KY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter of Tennessee and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kentucky Medical Specialists, Psc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Kentucky Medical Specialists, Psc, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Marlon Chagua, M.D.
Internal Medicine
NPI 1407811870
4001 KRESGE WAY STE 236
Louisville, KY 40207
(502) 893-7372
✔ PECOSSame address
Hannah Jazdzewski, MSN, AGPCNP
Nurse Practitioner
NPI 1194441113
4001 KRESGE WAY STE 236
Louisville, KY 40207
(502) 893-7372
✔ PECOSSame address
James Packer, APRN
Nurse Practitioner
NPI 1730835968
4001 KRESGE WAY STE 236
Louisville, KY 40207
(502) 893-7372
✔ PECOS✔ Accepts MedicareSame address
Debra Strotman, APRN
Nurse Practitioner
NPI 1679608152
4001 KRESGE WAY STE 236
Louisville, KY 40207
(502) 893-7372
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Waiver 18D1008432

Kentucky Medical Specialists, Psc · Louisville, KY
Active · expires May 25, 2028
CLIA Number18D1008432
Laboratory TypePhysician Office
Certificate Effective DateMay 26, 2026
Certificate Expiration DateMay 25, 2028
Laboratory DirectorMr. Marlon Chagua
Laboratory Phone(502) 893-7372
Laboratory LocationKentucky Medical Specialists, Psc4001 Kresge Way, Suite 236, Louisville, KY 40207
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Kentucky Medical Specialists, Psc's NPI number?

The NPI number for Kentucky Medical Specialists, Psc is 1295090884. It was assigned to this organization in the NPPES registry on July 10, 2012.

Where is Kentucky Medical Specialists, Psc located?

Kentucky Medical Specialists, Psc is located at 4001 Kresge Way Ste # 236, Louisville, KY 40207. The listed phone number is (502) 893-7372.

What is Kentucky Medical Specialists, Psc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kentucky Medical Specialists, Psc enrolled in Medicare?

Yes. Kentucky Medical Specialists, Psc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kentucky Medical Specialists, Psc?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Kentucky Medical Specialists, Psc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3) and Internal Medicine (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Kentucky Medical Specialists, Psc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D1008432) is associated with this NPI, valid through May 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kentucky Medical Specialists, Psc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter of Tennessee and Anthem Blue Cross and Blue Shield list Kentucky Medical Specialists, Psc 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 Kentucky Medical Specialists, Psc was last updated on May 1, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.