NPIMap

Organization Active NPI

Cumberland Family Clinic, PLLC

  • Rural Health Clinic/Center
  • Pine Knot, KY
National Provider Identifier
1366703159
Registry record updated Jun 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CUMBERLAND FAMILY CLINIC, PLLC
Practice address
57 Hogue Rd
Pine Knot, KY 42635
Phone
(606) 310-9737
NPI assigned
Jun 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2012

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

Authorized official

Name
Monica S Lawson
Title
Partner
Phone
(606) 310-9737

Specialties & licenses 1

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

Addresses

Primary practice location

57 Hogue Rd
Pine Knot, KY 42635

Mailing address

PO Box 300
Pine Knot, KY 42635-0300
Phone (606) 310-9737

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130411000038 KY Part B Supplier - Clinic/Group Practice 0749426047 Receives reassigned benefits from 5 practitioners
Practice locations: Pine Knot, KY
O20130508000272 KY Part A Provider - Rural Health Clinic 0749426047 Practice locations: Pine Knot, KY

Rural health clinic certification: CCN 188930

Legal name
CUMBERLAND FAMILY CLINIC, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 5, 2013
Last certification
Mar 5, 2026
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Mar 1, 2012 in KY
Enrollment address
57 Hogue Rd
Pine Knot, KY 42635-7003

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
18D2051437Cumberland Family Clinic PLLC57 Hogue Road, Pine Knot, KY 42635AccreditationJul 16, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Monica Lawson Individual 5% Or Greater Direct Ownership Interest Mar 1, 2012 50%
W-2 Managing EmployeeOffice Manager, Owner Mar 1, 2012
Tammie Lynn Emerson-Johnson Individual 5% Or Greater Direct Ownership Interest Mar 1, 2012 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339027200000",
    "number": "1366703159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "city": "PINE KNOT",
            "state": "KY",
            "postal_code": "426350300",
            "telephone_number": "606-310-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 HOGUE RD",
            "city": "PINE KNOT",
            "state": "KY",
            "postal_code": "42635",
            "telephone_number": "606-310-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-07",
        "last_updated": "2012-06-07",
        "status": "A",
        "authorized_official_last_name": "LAWSON",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "606-310-9737"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Knot, KY

Sources for this page

Verify at the official NPI Registry.