Cumberland Family Medical Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CUMBERLAND FAMILY MEDICAL CENTER INC

Doing business as

Lebanon Elementary Healthy Kids Clinic

Practice address

420 W Main St
Lebanon, KY 40033-1363

Phone

(270) 692-3883

Fax

(270) 858-4029

NPI assigned

Jun 6, 2019

Last updated

Sep 18, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eric E Loy, MD

Title

Ceo

Phone

(270) 858-6655

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lebanon Elementary Healthy Kids Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154980902. Details of each certification follow.

• CCN 181152 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181152

Legal name

LEBANON ELEMENTARY HEALTHY KIDS CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 13, 2019

Last certification

Sep 13, 2019

Ownership / control type

For profit – partnership

Facility address

420 W. Main Street
Lebanon, KY 40033

Locations

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1154980902",
    "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": "270-585-6655",
            "fax_number": "270-858-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W MAIN ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331363",
            "telephone_number": "270-692-3883",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "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": "MD"
    },
    "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": "Lebanon Elementary Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jody Coomer, APRN
• Sarah Grace Coulter, MSPT
• Roderick D Coxon, D.C.
• Chelsea Crutchfield
• Cumberland Family Medical Center Inc (Marion County Knight Academy Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Calvary Elementary Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Marion County Middle Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Glasscock Elementary Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Marion County High Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Healthy Kids Clinic- Lebanon Pediatrics)

• Federally Qualified Health Center (FQHC) in Lebanon, KY
• Providers in Lebanon, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.