NPIMap

Organization Active NPI

Central Kentucky Recovery Management

Doing business as New Life Recovery

  • Addiction Medicine (Family Medicine) Physician
  • Cynthiana, KY
National Provider Identifier
1619339736
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
CENTRAL KENTUCKY RECOVERY MANAGEMENT
Doing business as
New Life Recovery
Practice address
1094 US Highway 27 S Ste a
Cynthiana, KY 41031-7078
Phone
(859) 569-3145
Fax
(859) 569-3176
NPI assigned
Mar 28, 2016
Last updated
Jun 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Authorized official

Name
Tracy S FrymanNPI 1346585767
Title
Owner
Phone
(859) 569-3145

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
Addiction Medicine (Family Medicine) Physician 207QA0401X NU Primary
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

1094 US Highway 27 S Ste a
Cynthiana, KY 41031-7078

Mailing address

1094 US Highway 27 S Ste a
Cynthiana, KY 41031-7078
Phone (859) 569-3145

Other identifiers 2

IdentifierTypeStateIssuer
7100435380MedicaidKY
810849OtherKYAODE LICENSE

Other names 1

  • New Life Recovery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170303001533 KY Part B Supplier - Clinic/Group Practice 1557645884 Receives reassigned benefits from 2 practitioners
Practice locations: Cynthiana, KY

National Provider Directory

National Provider Directory

Locations

1094 US Highway 27 S
Ste A
Cynthiana, KY 41031
Phone (859) 569-3145

Practitioners & affiliated clinicians

Practitioners 6

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": "1459123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1619339736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1094 US HIGHWAY 27 S STE A",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410317078",
            "telephone_number": "859-569-3145",
            "fax_number": "859-569-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 US HIGHWAY 27 S STE A",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410317078",
            "telephone_number": "859-569-3145",
            "fax_number": "859-569-3176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL KENTUCKY RECOVERY MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-28",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "FRYMAN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-569-3145"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100435380",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AODE LICENSE",
            "identifier": "810849",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Life Recovery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Life Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cynthiana, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.