Thacker Family Medical LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

THACKER FAMILY MEDICAL LLC

Practice address

140 Adams LN Ste 600-700
Pikeville, KY 41501-3087

Phone

(606) 509-2000

Fax

(606) 509-2002

NPI assigned

Sep 10, 2021

Organization subpart

No

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

Authorized official

Name

Chadward L. Thacker, MDNPI 1801811542

Title

Owner

Phone

(606) 509-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

Rural health clinic certification: CCN B03876

Legal name

THACKER FAMILY MEDICAL LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 24, 2022

Last certification

Nov 20, 2024

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

140 Adams LN
Ste 600-700
Pikeville, KY 41501-3087

Other NPIs with the same Medicare PAC ID 1

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

• Thacker Family Medical LLC

  • Family Medicine Physician
  • Pikeville, KY
  • NPI 1629342985

  1557523057

  Same PAC ID

Locations

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.

• Chadward Thacker, MD

  • Family Medicine Physician
  • Pikeville, KY
  • NPI 1801811542

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

  CMS ownership

Practitioners 2

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

• Billie Bartley, PAC

  • Physician Assistant
  • Pikeville, KY
  • NPI 1184688855
  Medicare reassignment Care Compare group NPD
• Chadward Thacker, MD

  • Family Medicine Physician
  • Pikeville, KY
  • NPI 1801811542
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1134898364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 ADAMS LN STE 600-700",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013087",
            "telephone_number": "606-509-2000",
            "fax_number": "606-509-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 ADAMS LN STE 600-700",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013087",
            "telephone_number": "606-509-2000",
            "fax_number": "606-509-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THACKER FAMILY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "CHADWARD",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-509-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robb Kellen Taylor, DO
• Sherri Micheall Taylor
• Staci Taylor, APRN
• Teal Group PLLC
• Teal Group, PLLC
• Thacker Family Medical LLC
• Thacker Family Medical, PLLC
• Andrew Blake Thacker
• Bridget Denise Thacker, LPN
• Brittany Thacker, BCBA-D

• Rural Health Clinic/Center in Pikeville, KY
• Providers in Pikeville, 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 Jan 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.