NPIMap

Organization Active NPI

Owensboro Health Twin Lakes Regional Medical Center, Inc

Doing business as Owensboro Health Twin Lakes Medical Center Family Medicine

  • Rural Health Clinic/Center
  • Caneyville, KY
National Provider Identifier
1346846268
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC
Doing business as
Owensboro Health Twin Lakes Medical Center Family Medicine
Practice address
301 Sunset Dr
Caneyville, KY 42721-9172
Phone
(270) 879-3711
NPI assigned
Dec 7, 2020
Last updated
Dec 7, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Authorized official

Name
Russell S Ranallo
Title
Vice President of Finance
Phone
(270) 685-7180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

301 Sunset Dr
Caneyville, KY 42721-9172

Mailing address

PO Box 23229
Owensboro, KY 42304-3229
Phone (270) 688-1330

Other identifiers 1

IdentifierTypeStateIssuer
7100734490MedicaidKY

Other names 1

  • Owensboro Health Twin Lakes Medical Center Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210128002561 KY Part A Provider - Rural Health Clinic 3779996558 Practice locations: Caneyville, KY
O20250307001740 KY Part B Supplier - Clinic/Group Practice 3779996558 Receives reassigned benefits from 2 practitioners
Practice locations: Caneyville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346846268. Details of each certification follow.

Rural health clinic certification: CCN 188532

Legal name
OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC
Doing business as
OWENSBORO HEALTH TWIN LAKES MEDICAL CENTER FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 8, 2020
Last certification
Aug 24, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 2020 in KY
Enrollment address
301 Sunset Dr
Caneyville, KY 42721-9172
Related CCNs
180070

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

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
18D1000224Owensboro Health Twin Lakes Medical Center301 Sunset Drive, Caneyville, KY 42721Certificate of waiverJan 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Owensboro Health Twin Lakes3 organizations share this tax ID, including this one
Part of
Owensboro Health Twin Lakes

Other organizations with this tax ID 2

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

Locations

301 Sunset Dr
Caneyville, KY 42721
Phone (270) 879-3711

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Russell S Ranallo Individual Corporate OfficerCfo Jun 13, 2022
Corporate DirectorTreasurer Jun 13, 2022
Owensboro Health, Inc Organization, Owensboro, KY Corporation, Non-profit Operational/Managerial Control Jan 1, 2021 100%
Donna Vanmeter Individual Corporate DirectorBoard Member Oct 31, 2023
Laura Chapman Individual Corporate DirectorVice Chair Oct 31, 2023
Matt Hayes Individual Corporate DirectorSecretary Nov 27, 2023
Ashley Herrington Individual Corporate OfficerChief Operating Officer Jan 1, 2021
W-2 Managing EmployeeAdministrator/Coo Jan 1, 2021
Mark a Marsh Individual Corporate OfficerPresident Jun 7, 2021
Michael Joseph Scherm Individual Corporate DirectorChair Nov 26, 2024
Scott Majors Individual Corporate DirectorBoard Member Oct 31, 2023
Patricia Osborne Individual Corporate DirectorBoard Member Nov 27, 2023
Angee McCreery Individual Corporate DirectorBoard Member Nov 24, 2025

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 6

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2021 Change of OwnershipThis provider was the buyer Twin Lakes Caneyville Family PracticeCCN 188532, KY, NPI 1164054664

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1346846268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SUNSET DR",
            "city": "CANEYVILLE",
            "state": "KY",
            "postal_code": "427219172",
            "telephone_number": "270-879-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OWENSBORO HEALTH TWIN LAKES REGIONAL MEDICAL CENTER, INC",
        "enumeration_date": "2020-12-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "RANALLO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "270-685-7180"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100734490",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Owensboro Health Twin Lakes Medical Center Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caneyville, KY

Sources for this page

Verify at the official NPI Registry.