NPIMap

Organization Active NPI

Lakeside Primary Care, PSC

  • Rural Health Clinic/Center
  • Somerset, KY
National Provider Identifier
1043790983
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAKESIDE PRIMARY CARE, PSC
Practice address
6470 S Hwy 27
Somerset, KY 42501
Phone
(606) 341-1339
Fax
(606) 341-1340
NPI assigned
Aug 20, 2018
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Mrs. Thuresa S Cash, APRNNPI 1659511103
Title
Aprn/Owner
Phone
(606) 341-1339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X
Acute Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2100X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

6470 S Hwy 27
Somerset, KY 42501

Mailing address

PO Box 85
Burnside, KY 42519
Phone (606) 310-2640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181029000692 KY Part A Provider - Rural Health Clinic 1153674700 Practice locations: Somerset, KY
O20181120001820 KY Part B Supplier - Clinic/Group Practice 1153674700 Receives reassigned benefits from 10 practitioners
Practice locations: Somerset, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043790983. Details of each certification follow.

Rural health clinic certification: CCN 183801

Legal name
LAKESIDE PRIMARY CARE PSC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 27, 2019
Last certification
Feb 27, 2019
Ownership / control type
2A
Organization structure
CorporationProprietary
Incorporated
Jul 24, 2018 in KY
Enrollment address
6470 S Highway 27
Somerset, KY 42501-6075

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2156385Lakeside Primary Care6470 S Hwy 27, Somerset, KY 42501Certificate of waiverOct 16, 2026

National Provider Directory

National Provider Directory

Locations

6470 S Highway 27
Somerset, KY 42501
Phone (606) 341-1201

4807 Hermitage Rd
Ste 102
Richmond, VA 23227
Phone (804) 262-7888

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Lakeside Primary Care PSC Organization, Somerset, KY 5% Or Greater Direct Ownership Interest Aug 9, 2018
Thuresa S Cash Individual 5% Or Greater Direct Ownership Interest50 Jul 24, 2018
Corporate OfficerVP Jul 24, 2018
Operational/Managerial ControlVP Jul 24, 2018
Alisha J Cooley Individual 5% Or Greater Direct Ownership InterestPresident Jul 24, 2018
Corporate OfficerPresident Jul 24, 2018
W-2 Managing EmployeePresident Jul 24, 2018
Operational/Managerial ControlPresident Jul 24, 2018

Owners & managing parties with NPI records 2

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

  • Thuresa S. Cash, APRN
    • Family Nurse Practitioner
    • Whitley City, KY
    • NPI 1659511103

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership
  • Alisha J Cooley, APRN
    • Family Nurse Practitioner
    • Somerset, KY
    • NPI 1851699060

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1043790983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85",
            "city": "BURNSIDE",
            "state": "KY",
            "postal_code": "42519",
            "telephone_number": "606-310-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 S HWY 27",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "42501",
            "telephone_number": "606-341-1339",
            "fax_number": "606-341-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PRIMARY CARE, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-20",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "CASH",
        "authorized_official_first_name": "THURESA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "APRN/OWNER",
        "authorized_official_telephone_number": "606-341-1339",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerset, KY

Sources for this page

Verify at the official NPI Registry.