NPIMap

Organization Active NPI

Cumberland Family Medical Center Inc

Doing business as Sunrise Glen Dale Center Healthy Kids Clinic

  • Federally Qualified Health Center (FQHC)
  • Elizabethtown, KY
National Provider Identifier
1720799224
Registry record updated Sep 4, 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
Sunrise Glen Dale Center Healthy Kids Clinic
Practice address
1030 Commerce Drive
Elizabethtown, KY 42701-1281
Phone
(502) 538-1000
Fax
(270) 858-4029
NPI assigned
Dec 6, 2022
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Eric E Loy, MD
Title
Ceo
Phone
(270) 858-6655

Specialties & licenses 1

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

Addresses

Primary practice location

1030 Commerce Drive
Elizabethtown, KY 42701-1281

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7100017280MedicaidKY

Other names 1

  • Sunrise Glen Dale Center 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
O20230407001382 KY Part A Provider - Federally Qualified Health Center (FQHC) 6305947789 Practice locations: Elizabethtown, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720799224. Details of each certification follow.

Federally qualified health center certification: CCN B01127

Legal name
CUMBERLAND FAMILY MEDICAL CENTER INC
Doing business as
SUNRISE GLEN DALE CENTER HEALTHY KIDS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 22, 2024
Last certification
Mar 22, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 2005 in KY
Enrollment address
1030 Commerce Dr
Elizabethtown, KY 42701-1281

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

130 Commerce Dr
Elizabethtown, KY 42701

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 OfficerCeo Jul 1, 2007
W-2 Managing EmployeeCeo Jul 1, 2007
Paula S Little Individual Corporate DirectorBoard Member Jul 1, 2007
Larry K Riddle Individual Corporate DirectorBoard Member Sep 4, 2007
Josh Hardin Individual Corporate OfficerSecretary Feb 1, 2014
Corporate DirectorSecretary/Board Member Feb 1, 2014
Elizabeth T Everley Individual Corporate DirectorBoard Member Jun 19, 2012
Lisa Tarter Individual Corporate DirectorBoard Member Nov 28, 2017
James R Flowers Individual Corporate DirectorBoard Member Aug 1, 2009
Rebecca Radford Individual Corporate DirectorBoard Member Apr 19, 2016
Terry Grider Individual Corporate DirectorBoard Member Apr 19, 2016
Bridget L Booher Individual Corporate OfficerChairperson Feb 12, 2008
Corporate DirectorChairperson/Board Member Feb 12, 2008
Garyon Scott Individual Corporate DirectorBoard Member 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

NPI Registry JSON

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

{
    "created_epoch": "1670284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1720799224",
    "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": "270-858-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 COMMERCE DRIVE",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427011281",
            "telephone_number": "502-538-1000",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-06",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "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": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100017280",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Glen Dale Center Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sunrise Glen Dale Center Healthy Kids Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethtown, KY

Sources for this page

Verify at the official NPI Registry.