Mercy Medical Clinic PLLC
Organization Active NPI Family Medicine Physician · Corbin, KY
NPI 1528557147 · NPPES record last updated May 9, 2018
Key facts
- NPI
- 1528557147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MERCY MEDICAL CLINIC PLLC
- Practice address
- 14659 US N Hwy 25E
Ste 16
Corbin, KY 41701 - Phone
- (606) 280-7070
- NPI assigned
- May 9, 2018
- Organization subpart
- No
Authorized official
- Name
- Kathryn Baker, APRN
- Title
- Owner
- Phone
- (606) 280-7070
Owners & managing parties with NPI records 1
-
Kathryn Baker, APRN, FNP-C
Practitioners 6
-
Kathryn Baker, APRN, FNP-C
-
Ashley Barton, NP
-
Keisha Shae Perkins, APRN
-
Sydni Walden, APRN, FNP-C
-
Sarah Lucy Wright, LPCC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 188996
- Legal name
- MERCY MEDICAL CLINIC PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 25, 2018
- Last certification
- Oct 25, 2018
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 5, 2018 in KY
- Enrollment address
- 14659 US N Hwy 25E
Ste 16
Corbin, KY 40701
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Kathryn E Baker |
5% Or Greater Direct Ownership Interest |
Aug 1, 2018 | 100% |
| Corporate Officer |
Feb 5, 2018 | ||
| W-2 Managing Employee | Aug 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180713001439 | KY | Part B Supplier - Clinic/Group Practice | 5597011072 |
Receives reassigned benefits from 6 practitioners Practice locations: Corbin, KY |
| O20180926000814 | KY | Part a Provider - Rural Health Clinic | 5597011072 | Practice locations: Corbin, KY |
National Provider Directory
Locations
3110 Cumberland Falls Hwy
Corbin, KY 40701
Phone (606) 523-9386
14659 N US Highway 25 E
Corbin, KY 40701
Phone (606) 280-7772
615 Meyers Baker Rd
London, KY 40741
Phone (606) 657-2345
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
14659 US N Hwy 25E
Ste 16
Corbin, KY 41701
Mailing address
14659 US N Hwy 25E
Ste 16
Corbin, KY 41701
Other providers in Corbin, KY
- Kristen Faith Meeks-Cox
- Krupa Mehta
- Melissa L F Knuckles MD PSC
- Ashley Melton
- Sarah Mendez
- Angela Dawn Merritt
- Brenda L Messer-Johnson
- Amanda Beth Messer
- Cody Allen Messer
- Jamie Messer
All providers in Corbin, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.