Southeast Family Practice PSC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SOUTHEAST FAMILY PRACTICE PSC

Practice address

222 W Tennessee Ave
Pineville, KY 40977-1737

Phone

(606) 499-5135

NPI assigned

May 22, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trampas S Nolan, APRNNPI 1033144191

Title

Aprn / Owner

Phone

(606) 654-6210

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 183803

Legal name

SOUTHEAST FAMILY PRACTICE PSC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 29, 2019

Last certification

Jan 8, 2019

Ownership / control type

1A

Organization structure

CorporationProprietary

Incorporated

May 10, 2018 in KY

Enrollment address

12904 Robert L Madon Byp
Ste 2
Pineville, KY 40977-8063

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DECFBD

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Trampas S Nolan, ARNP

  • Family Nurse Practitioner
  • Pineville, KY
  • NPI 1033144191

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trampas S Nolan, ARNP

  • Family Nurse Practitioner
  • Pineville, KY
  • NPI 1033144191
  Medicare reassignment Care Compare group NPD Authorized official
• Aaron N. Frye, APRN, FNP-BC

  • Family Nurse Practitioner
  • Beverly, KY
  • NPI 1083030860
  Medicare reassignment Care Compare group NPD
• Jennie Katelyn Nolan, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pineville, KY
  • NPI 1659054534
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1033600416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W TENNESSEE AVE",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771737",
            "telephone_number": "606-499-5135",
            "fax_number": "606-654-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W TENNESSEE AVE",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771737",
            "telephone_number": "606-499-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST FAMILY PRACTICE PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "TRAMPAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "APRN / OWNER",
        "authorized_official_telephone_number": "606-654-6210",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shannon L Smith, CRNA
• Timothy Roberts Smith
• Steven K. Morgan, M.D PSC
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• Rural Health Clinic/Center in Pineville, KY
• Providers in Pineville, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.