NPIMap

Organization Active NPI

Cumberland Family Medical Center Inc

Doing business as Lighthouse Academy/Jackson Academy Healthy Kids Clinic

  • Federally Qualified Health Center (FQHC)
  • Bowling Green, KY
National Provider Identifier
1689391864
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CUMBERLAND FAMILY MEDICAL CENTER INC
Doing business as
Lighthouse Academy/Jackson Academy Healthy Kids Clinic
Practice address
877 Jackson Street
Bowling Green, KY 42101-5195
Phone
(844) 435-0900
Fax
(270) 858-4029
NPI assigned
Oct 27, 2022
Last updated
Oct 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Authorized official

Name
Eric E Loy, M.D.
Title
Ceo
Phone
(270) 858-6655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

877 Jackson Street
Bowling Green, KY 42101-5195

Mailing address

PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655

Other identifiers 1

IdentifierTypeStateIssuer
7100017280MedicaidKY

Other names 1

  • Lighthouse Academy/Jackson Academy Healthy Kids Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230324000881 KY Part A Provider - Federally Qualified Health Center (FQHC) 6305947789 Practice locations: Bowling Green, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689391864. Details of each certification follow.

Federally qualified health center certification: CCN 181976

Legal name
CUMBERLAND FAMILY MEDICAL CENTER INC
Doing business as
LIGHTHOUSE ACADEMY/JACKSON ACADEMY HEALTHY KIDS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2023
Last certification
Feb 24, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 2005 in KY
Enrollment address
877 Jackson St
Bowling Green, KY 42101-5195

National Provider Directory

National Provider Directory
Tax ID family
Cumberland Family Medical Inc142 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

877 Jackson St
Bowling Green, KY 42101
Phone (270) 782-5410

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Eric E Loy Individual Corporate Officer Jul 1, 2007
W-2 Managing EmployeeCeo Jul 1, 2007
Paula S Little Individual Corporate Director Jul 1, 2007
Other Jul 1, 2007
Larry K Riddle Individual Corporate Director Sep 4, 2007
Other Sep 4, 2007
Josh Hardin Individual Corporate Officer Feb 1, 2014
Corporate Director Feb 1, 2014
Other Feb 1, 2014
Elizabeth T Everley Individual Corporate Director Jun 19, 2012
Other Jun 19, 2012
Lisa Tarter Individual Corporate Director Nov 28, 2017
Other Nov 28, 2017
James R Flowers Individual Corporate Director Aug 1, 2009
Other Aug 1, 2009
Rebecca Radford Individual Corporate Director Apr 19, 2016
Other Apr 19, 2016
Terry Grider Individual Corporate Director Apr 19, 2016
Other Apr 19, 2016
Bridget L Booher Individual Corporate Officer Feb 12, 2008
Corporate Director Feb 12, 2008
Other Feb 12, 2008
Garyon Scott Individual Corporate Director Jun 17, 2008
Other Jun 17, 2008

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Alavaton Elementary Healthy Kids ClinicAlvaton, KY, CCN 181975 Federally qualified health center Operational/Managerial Control Jul 1, 2007

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759881600000",
    "number": "1689391864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6655",
            "fax_number": "270-858-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 JACKSON STREET",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421015195",
            "telephone_number": "844-435-0900",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A",
        "authorized_official_last_name": "LOY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-858-6655",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100017280",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Academy/Jackson Academy Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lighthouse Academy/Jackson Academy Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.