NPIMap

Organization Active NPI

Lake Cumberland Physician Practices, LLC

  • Pain Medicine Physician
  • Somerset, KY
National Provider Identifier
1730489840
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Practice address
305 Langdon Street
Suite P
Somerset, KY 42503
Phone
(606) 676-0206
Fax
(606) 676-0220
NPI assigned
Oct 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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

Authorized official

Name
Sara Miller
Title
Director
Phone
(615) 920-7514

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

305 Langdon Street
Suite P
Somerset, KY 42503

Mailing address

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7000

Other identifiers 1

IdentifierTypeStateIssuer
7100143770MedicaidKY

Other names 1

  • Pain Center of Lake Cumberland Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090504000210 KY Part B Supplier - Clinic/Group Practice 2567510464 Receives reassigned benefits from 87 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerset, KY; Whitley City, KY; Springfield, KY; London, KY; Russell Springs, KY; Harlan, KY

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Lake Cumberland Physician Practices LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

305 Langdon St
Ste P
Somerset, KY 42503
Phone (606) 676-0206

305 Langdon St
#P
Somerset, KY 42503
Phone (606) 676-0206

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1730489840",
    "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": "37027",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 LANGDON STREET",
            "address_2": "SUITE P",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "42503",
            "telephone_number": "606-676-0206",
            "fax_number": "606-676-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-25",
        "last_updated": "2017-09-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-920-7514"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100143770",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain Center of Lake Cumberland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerset, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; 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.