NPIMap

Organization Active NPI

Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
National Provider Identifier
1295960532
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PINELAKE PHYSICIAN PRACTICE, LLC
Practice address
1111 Medical Center Cir
Mayfield, KY 42066-1194
Phone
(270) 251-4543
Fax
(270) 251-4544
NPI assigned
May 15, 2009
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7688

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1111 Medical Center Cir
Mayfield, KY 42066-1194

Mailing address

330 Seven Springs Way
Atten: Provider Enrollment
Brentwood, TN 37027-5098
Phone (615) 920-7192

Other identifiers 2

IdentifierTypeStateIssuer
000000618910OtherKYANTHEM
7100335050MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040115001094 KY Part B Supplier - Clinic/Group Practice 6800797507 Receives reassigned benefits from 71 practitioners
12 other NPIs on this enrollment
Practice locations: Benton, KY; Paducah, KY; Mayfield, KY; Hickman, KY; Fulton, KY; Clinton, KY
O20140205000338 KY Part A Provider - Rural Health Clinic 6800797507 Practice locations: Mayfield, KY
O20170721003041 KY Part A Provider - Rural Health Clinic 6800797507 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fulton, KY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1295960532. Details of each certification follow.

Rural health clinic certification: CCN 188937

Legal name
PINELAKE PHYSICIAN PRACTICE LLC
Doing business as
JACKSON PURCHASE PRIMARY CARE MAYFIELD CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 17, 2014
Last certification
Jun 17, 2014
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Nov 19, 1998 in DE
Enrollment address
1111 Medical Center Cir
Mayfield, KY 42066-1194

Rural health clinic certification: CCN 188981

Legal name
PINELAKE PHYSICIAN PRACTICE LLC
Doing business as
JACKSON PURCHASE PRIMARY CARE FULTON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 6, 2018
Last certification
Jul 6, 2018
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Nov 19, 1998 in DE
Enrollment address
101 Main St
Fulton, KY 42041-1601

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2007977Jackson Purchase Primary Care Mayfield Clinic1111 Medical Center Circle, Mayfield, KY 42066Certificate of waiverJun 1, 2028
18D2013924Jackson Purchase Primary Care Mayfield Clinic1111 Medical Center Circle, Mayfield, KY 42066Certificate of waiverSep 27, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lifepoint Holdings 2 LLC Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Apr 28, 2009 100%
5% Or Greater Indirect Ownership Interest Feb 1, 2017 100%
Pamela Kane Individual Corporate OfficerVice President Aug 9, 2022
Lifepoint of Kentucky LLC Organization, Brentwood, TN LLC 5% Or Greater Direct Ownership Interest Apr 28, 2009 100%
5% Or Greater Direct Ownership Interest Feb 1, 2017 100%
DSB Acquisition LLC Organization, New York, NY For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Hospitals Holdings LLC Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Apr 28, 2009 100%
5% Or Greater Indirect Ownership Interest Feb 1, 2017 100%
Historic Lifepoint Hospitals, LLC Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Apr 28, 2009 100%
5% Or Greater Indirect Ownership Interest Feb 1, 2017 100%
Lifepoint Health Inc Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Jan 21, 2022
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Klaus Michael Boel Individual Corporate OfficerPresident Aug 19, 2024
W-2 Managing Employee Aug 19, 2024
Christopher J Monte Individual Corporate OfficerVice President Nov 1, 2013
Corporate OfficerVice President Jan 1, 2017
Legacy Lifepoint Health LLC Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%

Facilities with the same owner 193

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Bourbon Community Hospital LLC

    dba Bourbon Community Hospital

    • Rural Acute Care Hospital
    • Paris, KY
    • NPI 1427132158

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Bourbon Community Hospital LLC

    dba Bourbon Community Hospital

    • Psychiatric Hospital Unit
    • Paris, KY
    • NPI 1902089865

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Bourbon Physician Practice LLC

    dba Bluegrass Family Clinic

    • Rural Health Clinic/Center
    • Paris, KY
    • NPI 1962111716

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Family Medicine - Mt. Sterling

    • Rural Health Clinic/Center
    • Mt Sterling, KY
    • NPI 1780356253

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Family Medicine - Winchester Boonesboro Road

    • Rural Health Clinic/Center
    • Winchester, KY
    • NPI 1831852771

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Primary Care - Winchester

    • Rural Health Clinic/Center
    • Winchester, KY
    • NPI 1841953783

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Fleming Medical Center LLC

    dba Fleming County Hospital

    • Critical Access Hospital
    • Flemingsburg, KY
    • NPI 1881726347

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Georgetown Community Hospital LLC

    dba Gerogetown Community Hospital

    • Rural Acute Care Hospital
    • Georgetown, KY
    • NPI 1326107319

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Kentucky Hospital, LLC

    dba Clark Regional Medical Center

    • General Acute Care Hospital
    • Winchester, KY
    • NPI 1811213994

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Kentucky in-Home Partner-I, LLC

    dba Lifeline of Jackson Purchase Home Health

    • Home Health Agency
    • Mayfield, KY
    • NPI 1508394594

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Kentucky Mso LLC

    dba Centerpoint Family Medicine - Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, KY
    • NPI 1922860758

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Lake Cumberland Regional Hospital LLC

    dba Lake Cumberland Medical Associates

    • Rural Health Clinic/Center
    • Somerset, KY
    • NPI 1023155462

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
View all 193

Practitioners & affiliated clinicians

Practitioners 73

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.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1295960532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "address_2": "ATTEN: PROVIDER ENROLLMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7192",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER CIR",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420661194",
            "telephone_number": "270-251-4543",
            "fax_number": "270-251-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELAKE PHYSICIAN PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-15",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7688"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000618910",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100335050",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayfield, KY

Sources for this page

Verify at the official NPI Registry.