Cumberland Family Medical Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

700172 Issued in KY

Legal business name

CUMBERLAND FAMILY MEDICAL CENTER, INC.

Doing business as

Lincoln County High Healthy Kids Clinic

Practice address

60 Education Way
Stanford, KY 40484-8411

Phone

(844) 435-0900

Fax

(270) 858-4029

NPI assigned

Mar 24, 2017

Last updated

Mar 24, 2017By 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

(240) 864-1472

Specialties & licenses 1

Addresses

Other names 1

• Lincoln County High Healthy Kids Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174054845. Details of each certification follow.

• CCN 181054 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181054

Legal name

LINCOLN COUNTY HIGH HEALTHY KIDS CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 22, 2018

Last certification

Jan 22, 2018

Ownership / control type

For profit – corporation

Facility address

60 Education Way
Stanford, KY 40484

Practitioners 1

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.

• Kimberly Dawn Phillips, APRN

  • Family Nurse Practitioner
  • Lawrenceburg, KY
  • NPI 1316387764
  NPD (past)

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490313600000",
    "number": "1174054845",
    "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": "270-858-6644",
            "fax_number": "270-858-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 EDUCATION WAY",
            "city": "STANFORD",
            "state": "KY",
            "postal_code": "404848411",
            "telephone_number": "844-435-0900",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-24",
        "last_updated": "2017-03-24",
        "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": "240-864-1472",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln County High Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Crase, MD
• Cumberland Family Medical Center Inc (Stanford Elementary Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Fort Logan Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (Lincoln County Middle Healthy Kids Clinic)
• Cumberland Family Medical Center Inc (First Choice Immediate Care Lincoln)
• Cumberland Foot and Ankle Center
• Ashley Daniels
• Gloria B Davis, MA
• Melissa F Day, PA-C
• Lindsay Joanna Degnan, COTA/L

• Federally Qualified Health Center (FQHC) in Stanford, KY
• Providers in Stanford, 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 Mar 24, 2017; 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.