NPIMap

Organization Active NPI

Lake Cumberland Physician Practices

Doing business as Lake Cumberland Weight Loss Physicians

  • Surgery Physician
  • Somerset, KY
National Provider Identifier
1417214669
Registry record updated Oct 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LAKE CUMBERLAND PHYSICIAN PRACTICES
Doing business as
Lake Cumberland Weight Loss Physicians
Practice address
154 Bogle Office Park Dr
Suite a
Somerset, KY 42503-2810
Phone
(606) 425-4695
Fax
(606) 425-4696
NPI assigned
Apr 12, 2012
Last updated
Oct 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2016

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

Authorized official

Name
Timothy D Vaughn
Title
Vice President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

154 Bogle Office Park Dr
Suite a
Somerset, KY 42503-2810

Mailing address

PO Box 719
Somerset, KY 42502-0719
Phone (606) 425-4695

Other names 1

  • Lake Cumberland Weight Loss Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090504000210 KY Part B Supplier - Clinic/Group Practice 2567510464 Receives reassigned benefits from 87 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerset, KY; Whitley City, KY; Springfield, KY; London, KY; Russell Springs, KY; Harlan, KY

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Lake Cumberland Physician Practices LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

163 Tower Cir
Somerset, KY 42503
Phone (606) 676-0786

Practitioners & affiliated clinicians

Practitioners 5

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": "1334188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1417214669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425020719",
            "telephone_number": "606-425-4695",
            "fax_number": "606-425-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 BOGLE OFFICE PARK DR",
            "address_2": "SUITE A",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032810",
            "telephone_number": "606-425-4695",
            "fax_number": "606-425-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CUMBERLAND PHYSICIAN PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-12",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Cumberland Weight Loss Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerset, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; 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.