NPIMap

Organization Active NPI

CCMH Corporation

Doing business as CCMH Surgical Practice

  • Surgery Physician
  • Carrollton, KY
National Provider Identifier
1528255692
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CCMH CORPORATION
Doing business as
CCMH Surgical Practice
Practice address
309 11TH St
Carrollton, KY 41008-1435
Phone
(502) 732-3299
NPI assigned
Oct 2, 2007
Last updated
Jun 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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

Authorized official

Name
Sheila Tomlinson
Title
Director of Clinical Services
Phone
(502) 732-3278

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

309 11TH St
Carrollton, KY 41008-1435

Mailing address

309 11TH St
Carrollton, KY 41008-1435
Phone (502) 732-3243

Other identifiers 4

IdentifierTypeStateIssuer
000000520557OtherKYANTHEM
2842264000OtherKYPASSPORT ADVANTAGE
50014767OtherKYPASSPORT
7100031750MedicaidKY

Other names 1

  • CCMH Surgical Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080108000723 KY Part B Supplier - Clinic/Group Practice 2365540465 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bedford, KY; Carrollton, KY; Warsaw, KY

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
CCMH Corporation9 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.

Practitioners & affiliated clinicians

Practitioners 9

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": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782086400000",
    "number": "1528255692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 11TH ST",
            "city": "CARROLLTON",
            "state": "KY",
            "postal_code": "410081435",
            "telephone_number": "502-732-3243",
            "fax_number": "502-732-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 11TH ST",
            "city": "CARROLLTON",
            "state": "KY",
            "postal_code": "410081435",
            "telephone_number": "502-732-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCMH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A",
        "authorized_official_last_name": "TOMLINSON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "502-732-3278"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000520557",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2842264000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50014767",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100031750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Surgical Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCMH Surgical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; 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.