MEDICARE: COMMUNITY MEDICAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106H00000X	Marriage & Family Therapist
2	170300000X	Genetic Counselor (M.S.)	KY
3	363LA2200X	Adult Health Nurse Practitioner
4	2251X0800X	Orthopedic Physical Therapist
5	363A00000X	Physician Assistant
6	363L00000X	Nurse Practitioner	KY
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	1041C0700X	Clinical Social Worker
9	2084P0800X	Psychiatry Physician
10	103TC0700X	Clinical Psychologist
11	2080S0010X	Pediatric Sports Medicine Physician	KY
12	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
13	363LA2100X	Acute Care Nurse Practitioner
14	207QS0010X	Sports Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386904647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5339

Provider Business Practice Location Address
First Line	:	1951 BISHOP LN FL 4
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1923
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5339

Authorized Official
Title or Position	:	VP- MANAGED CARE
Name	:	SHELLEY GAST
Credential	:
Telephone Number	:	502-588-9490

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	01/16/2026

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