NPIMap

Organization Active NPI

Monroe Medical Foundation Inc

Doing business as Monroe County Physician Associates

  • Rural Health Clinic/Center
  • Tompkinsville, KY
National Provider Identifier
1629655816
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MONROE MEDICAL FOUNDATION INC
Doing business as
Monroe County Physician Associates
Practice address
604 N Main St
Tompkinsville, KY 42167-1128
Phone
(270) 407-5150
NPI assigned
Mar 25, 2021
Last updated
Mar 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Authorized official

Name
Alisa Nichole Melton
Title
Asst. C.F.O.
Phone
(270) 487-9231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

604 N Main St
Tompkinsville, KY 42167-1128

Mailing address

529 Capp Harlan Rd
Tompkinsville, KY 42167-1808
Phone (270) 487-9231

Other names 1

  • Monroe County Physician Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210709002728 KY Part A Provider - Rural Health Clinic 5092702472 Practice locations: Tompkinsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629655816. Details of each certification follow.

Rural health clinic certification: CCN 188544

Legal name
MONROE MEDICAL FOUNDATION, INC.
Doing business as
MONROE COUNTY PHYSICIAN ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 11, 2022
Last certification
Oct 23, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 5, 1979 in KY
Enrollment address
604 N Main St
Tompkinsville, KY 42167-1128
Related CCNs
180105

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
18D1093981Monroe County Physician Associates604 N Main Street, Tompkinsville, KY 42167Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Monroe Medical Foundation Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Andrea L Rich-McLerran Individual Corporate OfficerCeo Jan 1, 2021
W-2 Managing EmployeeCeo Jan 1, 2021
Jimmy B Goodman Individual Corporate DirectorBoard Member Jan 1, 1979
Willie F. Ross Individual Corporate DirectorBoard Member Nov 1, 1983
Donnie Peden Individual Corporate DirectorBoard Member Jul 1, 2022
Gregory K Crabtree Individual Corporate DirectorBoard Member Oct 1, 2001
Caitlin Hagan Individual Corporate OfficerCfo Aug 1, 2023
W-2 Managing EmployeeCfo Aug 1, 2023
Anthony C Carter Individual Corporate DirectorBoard Member Jan 1, 2022
Alisa N Melton Individual W-2 Managing EmployeeAssistant Cfo Apr 15, 2021
Judith a Rowland Individual Corporate DirectorBoard Member May 1, 2001
Jack D Anderson Individual Corporate DirectorBoard Member Jan 1, 2023
Pauline M Baker Individual Corporate OfficerPresident of the Board of Directors Apr 1, 1995
Corporate DirectorBoard Member Apr 1, 1995
Kem Coe Individual Corporate DirectorBoard Member Aug 17, 2015

Owners & managing parties with NPI records 3

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1629655816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 CAPP HARLAN RD",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421671808",
            "telephone_number": "270-487-9231",
            "fax_number": "270-487-5784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N MAIN ST",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421671128",
            "telephone_number": "270-407-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE MEDICAL FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "ALISA",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "ASST. C.F.O.",
        "authorized_official_telephone_number": "270-487-9231"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe County Physician Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tompkinsville, KY

Sources for this page

Verify at the official NPI Registry.