NPIMap

Organization Active NPI

East Bernstadt Medical Clinic PLLC

Doing business as Annville Medical Clinic

  • Rural Health Clinic/Center
  • Annville, KY
National Provider Identifier
1336109644
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EAST BERNSTADT MEDICAL CLINIC PLLC
Doing business as
Annville Medical Clinic
Practice address
78 Highway 3444
Annville, KY 40402-8245
Phone
(606) 364-5162
Fax
(606) 364-3920
NPI assigned
Mar 23, 2006
Last updated
Oct 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Authorized official

Name
Carla Jean Johnson
Title
Billing/Credentialing Clerk
Phone
(606) 843-6195

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

78 Highway 3444
Annville, KY 40402-8245

Mailing address

2659 North Laurel Road
P O Box 495
East Bernstadt, KY 40729-0000
Phone (606) 843-6195

Other identifiers 1

IdentifierTypeStateIssuer
7100071750MedicaidKY

Other names 1

  • Annville Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
David J Hays5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

78 Highway 3444
Annville, KY 40402
Phone (606) 346-5162

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1336109644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2659 NORTH LAUREL ROAD",
            "address_2": "P O BOX 495",
            "city": "EAST BERNSTADT",
            "state": "KY",
            "postal_code": "407290000",
            "telephone_number": "606-843-6195",
            "fax_number": "606-843-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 HIGHWAY 3444",
            "city": "ANNVILLE",
            "state": "KY",
            "postal_code": "404028245",
            "telephone_number": "606-364-5162",
            "fax_number": "606-364-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BERNSTADT MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING CLERK",
        "authorized_official_telephone_number": "606-843-6195"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100071750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Annville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Annville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.