NPIMap

Organization Active NPI

Monroe Medical Foundation, Inc.

Doing business as Monroe County Medical Center Medical Practice

  • Family Medicine Physician
  • Tompkinsville, KY
National Provider Identifier
1083854434
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MONROE MEDICAL FOUNDATION, INC.
Doing business as
Monroe County Medical Center Medical Practice
Practice address
604 N Main St
Tompkinsville, KY 42167-1128
Phone
(270) 487-9231
Fax
(270) 487-5784
NPI assigned
Feb 25, 2009
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Mrs. Andrea L Rich-McLerran
Title
C.E.O.
Phone
(270) 487-9231

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

604 N Main St
Tompkinsville, KY 42167-1128

Mailing address

604 N Main St
Tompkinsville, KY 42167-1128
Phone (270) 487-9231

Other practice location 1

606 N Main St
Tompkinsville, KY 42167-1128
Phone (270) 487-6161

Other identifiers 2

IdentifierTypeStateIssuer
6592847500MedicaidKY
3954OtherKYGROUP

Other names 1

  • Monroe County Medical Center Medical Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040428000177 KY Part B Supplier - Clinic/Group Practice 5092702472 Receives reassigned benefits from 42 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glasgow, KY; Tompkinsville, KY
O20160810000287 TN Part B Supplier - Clinic/Group Practice 5092702472 Receives reassigned benefits from 1 practitioner
Practice locations: Celina, TN; Red Boiling Springs, TN

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

477 Capp Harlan Rd
Tompkinsville, KY 42167
Phone (270) 487-0701

Practitioners & affiliated clinicians

Practitioners 3

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": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1083854434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 N MAIN ST",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421671128",
            "telephone_number": "270-487-9231",
            "fax_number": "270-487-5784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N MAIN ST",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421671128",
            "telephone_number": "270-487-9231",
            "fax_number": "270-487-5784"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "606 N Main St",
            "address_purpose": "LOCATION",
            "city": "Tompkinsville",
            "state": "KY",
            "postal_code": "421671128",
            "country_code": "US",
            "telephone_number": "270-487-6161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MONROE MEDICAL FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "RICH-MCLERRAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "270-487-9231",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6592847500",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "3954",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe County Medical Center Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monroe County Medical Center Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tompkinsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.