Cumberland Family Medical Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CUMBERLAND FAMILY MEDICAL CENTER, INC.

Doing business as

MyLyfe-Kingsford Summer Shade

Practice address

Mylyfe-Kingsford Summer Shade
5126 Summer Shade Rd
Summer Shade, KY 42166-9701

Phone

(270) 406-8805

NPI assigned

Feb 17, 2022

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• MyLyfe-Kingsford Summer Shade Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1780339838",
    "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": "MYLYFE-KINGSFORD SUMMER SHADE",
            "address_2": "5126 SUMMER SHADE RD",
            "city": "SUMMER SHADE",
            "state": "KY",
            "postal_code": "421669701",
            "telephone_number": "270-406-8805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "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": "MyLyfe-Kingsford Summer Shade",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shirley Jean Hammer, M.S.CCCSLP
• Shelly M Moore, C.P.M.
• April Ramey
• Renee Elizabeth Rojas, CPM

• Federally Qualified Health Center (FQHC) in Summer Shade, KY
• Providers in Summer Shade, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.