NPIMap

Organization Active NPI

Elkton Clinic PSC

  • Internal Medicine Physician
  • Elkton, KY
National Provider Identifier
1457667461
Registry record updated Mar 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ELKTON CLINIC PSC
Practice address
713 W Main St
Elkton, KY 42220-9229
Phone
(270) 265-5353
NPI assigned
Aug 27, 2010
Last updated
Mar 24, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

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

Authorized official

Name
Dr. Manoj H Majmudar, MDNPI 1659336097
Title
Owner
Phone
(270) 886-8840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

713 W Main St
Elkton, KY 42220-9229

Mailing address

PO Box 487
Elkton, KY 42220-0487
Phone (270) 265-5353

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110517000097 KY Part A Provider - Rural Health Clinic 5597952861 Practice locations: Elkton, KY
O20140729000028 KY Part B Supplier - Clinic/Group Practice 5597952861 Receives reassigned benefits from 4 practitioners
Practice locations: Elkton, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457667461. Details of each certification follow.

Rural health clinic certification: CCN 188908

Legal name
ELKTON CLINIC PSC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 15, 2011
Last certification
Apr 4, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jun 1, 2010 in KY
Enrollment address
713W Main St
Elkton, KY 42220-9229

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
18D2016664Elkton Clinic713 West Main Street, Elkton, KY 42220Certificate of waiverNov 21, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Manoj H Majmudar Individual 5% Or Greater Direct Ownership Interest Jun 9, 2010 100%
Corporate OfficerPresident Jun 9, 2010 100%
Corporate DirectorSole Director Jun 9, 2010 100%
Operational/Managerial ControlOwner/Pres Jun 9, 2010 100%

Owners & managing parties with NPI records 1

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

  • Manoj H Majmudar, MD
    • Pulmonary Disease Physician
    • Hopkinsville, KY
    • NPI 1659336097

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 8

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": "1282867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1457667461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 487",
            "city": "ELKTON",
            "state": "KY",
            "postal_code": "422200487",
            "telephone_number": "270-265-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 W MAIN ST",
            "city": "ELKTON",
            "state": "KY",
            "postal_code": "422209229",
            "telephone_number": "270-265-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKTON CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-27",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "MAJMUDAR",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-886-8840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, KY

Sources for this page

Verify at the official NPI Registry.