NPIMap

Organization Active NPI

London Women's Care, LLC

  • Obstetrics & Gynecology Physician
  • London, KY
National Provider Identifier
1063454650
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
LONDON WOMEN'S CARE, LLC
Practice address
803 Meyers Baker Rd Ste 200
London, KY 40741-3040
Phone
(606) 878-3240
Fax
(606) 878-4308
NPI assigned
Jun 11, 2006
Last updated
Feb 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Authorized official

Name
Joann Nolan
Title
Vice President
Phone
(606) 878-3240

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X KY
Family Nurse Practitioner 363LF0000X KY
Advanced Practice Midwife 367A00000X KY
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

803 Meyers Baker Rd Ste 200
London, KY 40741-3040

Mailing address

803 Meyers Baker Rd
Ste 200
London, KY 40741-3039
Phone (606) 878-3240

Other identifiers 1

IdentifierTypeStateIssuer
35001619MedicaidKY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000406 KY Part A Provider - Rural Health Clinic 6204721566 Practice locations: London, KY
O20040316001110 KY Part B Supplier - Clinic/Group Practice 6204721566 Receives reassigned benefits from 58 practitioners
Practice locations: London, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063454650. Details of each certification follow.

Rural health clinic certification: CCN 183926

Legal name
LONDON WOMEN'S CARE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2004
Last certification
Jun 29, 2017
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
803 Meyers Baker Road
Suite 200
London, KY 40741-3040

National Provider Directory

National Provider Directory

Locations

803 Meyers Baker Rd
London, KY 40741
Phone (606) 878-1219

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Cameron Pariseau Individual Corporate OfficerSecretary Dec 21, 2018 100%
Alistair Madle Individual Corporate OfficerCeo Dec 31, 2020 100%
Operational/Managerial ControlCeo Dec 31, 2020 100%
Hera Midco LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 100%
Operational/Managerial Control Dec 31, 2020 100%
Women's Care Holdings Inc Organization, New York, NY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 21, 2018 100%
Hera Holdco Inc Organization, New York, NY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 100%
Operational/Managerial Control Dec 31, 2020 100%
Bcec Hera Holdings Delaware LP Organization, New York, NY For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 98%
Operational/Managerial Control Dec 31, 2020 100%
Women's Care Investments Inc Organization, New York, NY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 21, 2018 100%
Women's Care Kentucky LLC Organization, New York, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 21, 2018 100%
Operational/Managerial Control Dec 21, 2018 100%
Physician Business Services, LLC Organization, Tampa, FL LLC, For-profit Operational/Managerial Control Dec 31, 2020 100%

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1063454650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 MEYERS BAKER RD",
            "address_2": "STE 200",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407413039",
            "telephone_number": "606-878-3240",
            "fax_number": "606-878-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 MEYERS BAKER RD STE 200",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407413040",
            "telephone_number": "606-878-3240",
            "fax_number": "606-878-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONDON WOMEN'S CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "606-878-3240"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001619",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.