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	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1881192409
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	:	502-272-5165
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	:	502-272-5165
Fax Number	:	502-272-5339

Authorized Official
Title or Position	:	VP MANAGED CARE
Name	:	MS. SHELLEY GAST
Credential	:
Telephone Number	:	502-272-5165

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	03/26/2026

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