NPIMap

Organization Active NPI

Cumberland Family Medical Center Inc

Doing business as Southside Elementary Healthy Kids Clinic

  • Federally Qualified Health Center (FQHC)
  • Versailles, KY
National Provider Identifier
1083390330
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CUMBERLAND FAMILY MEDICAL CENTER INC
Doing business as
Southside Elementary Healthy Kids Clinic
Practice address
1300 Troy Pike
Versailles, KY 40383-9642
Phone
(859) 879-4660
Fax
(270) 858-4029
NPI assigned
Jun 22, 2023
Last updated
Aug 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Eric E Loy, M.D.
Title
Ceo
Phone
(270) 858-6655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1300 Troy Pike
Versailles, KY 40383-9642

Mailing address

PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655

Other identifiers 1

IdentifierTypeStateIssuer
7100017280MedicaidKY

Other names 1

  • Southside Elementary Healthy Kids Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250424001142 KY Part A Provider - Federally Qualified Health Center (FQHC) 6305947789 Practice locations: Versailles, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083390330. Details of each certification follow.

Federally qualified health center certification: CCN B01176

Legal name
CUMBERLAND FAMILY MEDICAL CENTER INC
Doing business as
SOUTHSIDE ELEMENTARY HEALTHY KIDS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2025
Last certification
Apr 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1300 Troy Pike
Versailles, KY 40383-9642

National Provider Directory

National Provider Directory
Tax ID family
Cumberland Family Medical Inc142 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Eric E Loy Individual Corporate OfficerCeo/Owner Jul 1, 2007
W-2 Managing EmployeeAd; Jul 1, 2007
Paula S Little Individual Corporate DirectorBoard Member Jul 1, 2007
Larry K Riddle Individual Corporate DirectorBoard Member Sep 4, 2007
Lacey Terry Individual Corporate DirectorBoard Member Jun 25, 2019
Josh Hardin Individual Corporate OfficerSecretary Feb 1, 2014
Corporate DirectorBoard Member Apr 1, 2014
Elizabeth T Everley Individual Corporate DirectorBoard Member Jun 19, 2012
Lisa Tarter Individual Corporate DirectorBoard Member Nov 28, 2017
James R Flowers Individual Corporate DirectorBoard Member Aug 1, 2009
Rebecca Radford Individual Corporate DirectorBoard Member Apr 19, 2016
Terry Grider Individual Corporate DirectorBoard Member Apr 19, 2016
Bridget L Booher Individual Corporate OfficerChairperson Feb 12, 2008
Corporate DirectorBoard Member Feb 12, 2008
Garyon Scott Individual Corporate DirectorBoard Member Jun 17, 2008

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Alavaton Elementary Healthy Kids ClinicAlvaton, KY, CCN 181975 Federally qualified health center Operational/Managerial Control Jul 1, 2007

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1083390330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6655",
            "fax_number": "270-858-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 TROY PIKE",
            "city": "VERSAILLES",
            "state": "KY",
            "postal_code": "403839642",
            "telephone_number": "859-879-4660",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-22",
        "last_updated": "2025-08-12",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "LOY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-858-6655",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100017280",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Elementary Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Versailles, KY

Sources for this page

Verify at the official NPI Registry.