Pine Mountain Clinic PSC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

29667 Issued in KY

Legal business name

PINE MOUNTAIN CLINIC PSC

Practice address

850 Riverview Rd
Pineville, KY 40977-1430

Phone

(606) 337-6047

Fax

(606) 337-0925

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Madhan Mohan, MD

Title

Owner

Phone

(606) 337-6047

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Rural health clinic certification: CCN 188947

Legal name

PINE MOUNTAIN CLINIC PSC

Organization structure

CorporationProprietary

Incorporated

Oct 1, 1993 in KY

Enrollment address

850 Riverview
Pineville, KY 40977-1400

Rural health clinic certification: CCN 188952

Legal name

PINE MOUNTAIN CLINIC, PSC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 12, 2015

Last certification

Oct 12, 2015

Ownership / control type

1B

Facility address

850 Riverview
Pineville, KY 40977

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.

• Madhan Mohan, MD

  • Internal Medicine Physician
  • Pineville, KY
  • NPI 1669482816

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 3

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

• Michell E. Caudill, PA-C

  • Physician Assistant
  • Mount Juliet, TN
  • NPI 1508491143
  NPD (past)
• Brandy Smith Floyd, PA

  • Medical Physician Assistant
  • Colquitt, GA
  • NPI 1881756716
  NPD (past)
• Devapiran Jaishankar, M.D.

  • Medical Oncology Physician
  • Greeneville, TN
  • NPI 1225038490
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1205054327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW RD",
            "address_2": "PO BOX 308",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-6047",
            "fax_number": "606-337-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW RD",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771430",
            "telephone_number": "606-337-6047",
            "fax_number": "606-337-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE MOUNTAIN CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "MOHAN",
        "authorized_official_first_name": "MADHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-337-6047",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "29667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65930851",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Page Elementary School
• Terry David Pannell, RN
• Charles Bobby Partin, ATC, LAT, ITAT
• Jamie Dewayne Partin, RPH
• Keith Allen Phipps, PTA
• Pineville City School
• Pineville Community Health Center Inc (Riverview Avenue Pharmacy)
• Pineville Community Health Center Inc
• Pineville Community Health Center Inc
• Pineville Community Health Center Inc

• Internal Medicine Physician in Pineville, KY
• Providers in Pineville, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; 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.