NPIMap

Organization Active NPI

Pinelake Physician Practice LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
National Provider Identifier
1679061071
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PINELAKE PHYSICIAN PRACTICE LLC
Practice address
110 S 9TH St
Mayfield, KY 42066-2208
Phone
(270) 247-7795
Fax
(270) 247-2602
NPI assigned
May 1, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Sara Miller
Title
Director
Phone
(615) 202-9581

Other NPIs on the same Medicare enrollment 12

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

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040115001094 KY Part B Supplier - Clinic/Group Practice 6800797507 Receives reassigned benefits from 71 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benton, KY; Paducah, KY; Mayfield, KY; Hickman, KY; Fulton, KY; Clinton, KY

National Provider Directory

National Provider Directory

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

110 S 9TH St
Mayfield, KY 42066-2208

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7905

Other names 1

NPPES NPI Registry
  • Jackson Purchase Primary Care Williams Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 1, 2018.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525132800000",
    "number": "1679061071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7905",
            "fax_number": "615-920-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S 9TH ST",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420662208",
            "telephone_number": "270-247-7795",
            "fax_number": "270-247-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELAKE PHYSICIAN PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2018-05-01",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-202-9581"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Purchase Primary Care Williams Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayfield, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.