NPIMap

Organization Active NPI

Lake Cumberland Physician Practices LLC

Doing business as Lake Cumberland Surgery Specialists

  • Surgery Physician
  • Somerset, KY
National Provider Identifier
1811396195
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LAKE CUMBERLAND PHYSICIAN PRACTICES LLC
Doing business as
Lake Cumberland Surgery Specialists
Practice address
26 Oxford Way Ste B
Somerset, KY 42503-2813
Phone
(615) 920-7000
NPI assigned
Aug 22, 2014
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Kathy Teague
Title
Avp
Phone
(615) 920-7000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU
Nurse Practitioner 363L00000X NU
Acute Care Nurse Practitioner 363LA2100X NU
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

26 Oxford Way Ste B
Somerset, KY 42503-2813

Mailing address

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

Other practice location 1

350 Hospital Way
Suite 270
Somerset, KY 42503
Phone (606) 425-4298

Other names 1

  • Lake Cumberland Surgery Specialists 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

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1811396195",
    "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": "26 OXFORD WAY STE B",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425032813",
            "telephone_number": "615-920-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Hospital Way",
            "address_2": "Suite 270",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "KY",
            "postal_code": "42503",
            "country_code": "US",
            "telephone_number": "606-425-4298",
            "fax_number": "606-425-4299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE CUMBERLAND PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "AVP",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Cumberland Surgery Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Cumberland Surgery Specialists",
            "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 23, 2021; 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.