Crofton Clinic PSC
Organization Active NPI Rural Health Clinic/Center · Crofton, KY
NPI 1194253245 · NPPES record last updated Mar 1, 2018
Key facts
- NPI
- 1194253245
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CROFTON CLINIC PSC
- Practice address
- 241 S Madisonville St
Crofton, KY 42217-8009 - Phone
- (270) 220-0420
- NPI assigned
- Jun 1, 2017
- Organization subpart
- No
Authorized official
- Name
- Manoj Majmudar, MD
- Title
- Owner
- Phone
- (270) 220-0240
Owners & managing parties with NPI records 1
-
Manoj H Majmudar, MD
Practitioners 9
-
Whitney Barnett Almy, APRN
-
Manoj H Majmudar, MD
-
Maresa E Muhlethaler, NP-C
-
Angela D Pogue, APRN, FNP-C
-
Kathy Gallaway, AGACNP-BC
-
Ebone Powers, FNP-BC
-
Chrystal Rogers, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2131611 | Crofton Clinic, PSC | Certificate of waiver | Jun 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 188963
- Legal name
- CROFTON CLINIC PSC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 31, 2017
- Last certification
- Oct 31, 2017
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jun 1, 2016 in KY
- Enrollment address
- 241 S Madisonville St
Crofton, KY 42217-8009
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Manoj H Majmudar |
5% Or Greater Direct Ownership Interest |
Jun 1, 2016 | |
| Corporate Officer |
Jun 1, 2016 | ||
| W-2 Managing Employee | Jun 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170630001481 | KY | Part a Provider - Rural Health Clinic | 8729357983 | Practice locations: Crofton, KY |
| O20170731002165 | KY | Part B Supplier - Clinic/Group Practice | 8729357983 |
Receives reassigned benefits from 9 practitioners Practice locations: Crofton, KY |
National Provider Directory
Locations
241 S Madisonville St
Crofton, KY 42217
Phone (270) 220-0240
1724 Kenton St
Ste 1B
Hopkinsville, KY 42240
Phone (270) 886-8840
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
241 S Madisonville St
Crofton, KY 42217-8009
Mailing address
241 S Madisonville St
Crofton, KY 42217-8009
Phone (270) 220-0240
Other providers in Crofton, KY
- Terry Ann Adkins
- Taylor Elizabeth Cline Allen
- Erika Danielle Champion
- Commonwealth Biomedical Research, LLC
- Crofton Dental Center PLLC
- Crofton Elementary School
- Crofton Pharmacy LLC
- Crofton Pharmacy, LLC
- Jerri Annette Fowler
All providers in Crofton, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.