NPIMap

Organization Active NPI

Bourbon Physician Practice LLC

  • Rural Health Clinic/Center
  • Carlisle, KY
National Provider Identifier
1356689079
Registry record updated Sep 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOURBON PHYSICIAN PRACTICE LLC
Practice address
107 S Broadway St
Carlisle, KY 40311-1150
Phone
(859) 289-4124
Fax
(859) 289-4126
NPI assigned
Jan 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2022

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

Authorized official

Name
Monica Bowman
Title
President
Phone
(615) 920-7000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

107 S Broadway St
Carlisle, KY 40311-1150

Mailing address

107 S Broadway St
Carlisle, KY 40311-1150
Phone (859) 289-4124

Other names 1

  • Carlisle Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130528000124 KY Part B Supplier - Clinic/Group Practice 8729226097 Receives reassigned benefits from 29 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cynthiana, KY; Maysville, KY; Paris, KY; Winchester, KY

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

1140 Lexington Rd
Ste 101
Georgetown, KY 40324
Phone (502) 863-5321

8 Linville Dr
Ste E
Paris, KY 40361
Phone (859) 340-1377

22 Clinic Dr
Paris, KY 40361
Phone (859) 987-0074

22 Clinic Dr
Ste 1RHC
Paris, KY 40361

225 Hospital Dr
Ste 315
Winchester, KY 40391
Phone (859) 737-6488

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663977600000",
    "number": "1356689079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S BROADWAY ST",
            "city": "CARLISLE",
            "state": "KY",
            "postal_code": "403111150",
            "telephone_number": "859-289-4124",
            "fax_number": "859-289-4126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S BROADWAY ST",
            "city": "CARLISLE",
            "state": "KY",
            "postal_code": "403111150",
            "telephone_number": "859-289-4124",
            "fax_number": "859-289-4126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOURBON PHYSICIAN PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-30",
        "last_updated": "2022-09-24",
        "certification_date": "2022-09-24",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carlisle Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carlisle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carlisle, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.