Clark Regional Physician Practices LLC
Organization Active NPI Rural Health Clinic/Center · Winchester, KY
NPI 1831852771 · NPPES record last updated Mar 18, 2026
Key facts
- NPI
- 1831852771
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CLARK REGIONAL PHYSICIAN PRACTICES LLC
- Practice address
- 1520 Boonesboro Rd
Winchester, KY 40391-8816 - Phone
- (859) 744-0067
- Fax
- (859) 744-0042
- NPI assigned
- Oct 18, 2021
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Facilities with the same owner 193
Practitioners 50
-
Maneesh Gaddam, M.D.
-
Kelly Miller, APRN
-
Kyle Michael Wiedemer, PA-C
-
Ekaterina Pik, PMHNP
-
Ashley Elizabeth Johnson, APRN
-
Thad Manning, DO
-
Kimberley K Privett, NURSE PRACTITIONER
-
Shelly M Rogers, MD
-
Mahmoud A. Abualayem, MD.
-
Stacey M Anderson, APRN
-
Leslie Ann Asbury, M.D.
-
Alexis Noel Budine-Utter, PA-C
-
John Austin Byrd, PA
-
Patrick Howard Counts, PA-C
-
Holly Craycraft, APRN-CNP
-
Kaitlyn Nicole Edwards, M.D.
-
Yousof E Elgaried, MBBS
-
Seth T Fritz, AUD
-
Maryann Hall, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0975398 | Clark Clinic Family Medicine | Certificate of waiver | Jul 6, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 183892
- Legal name
- CLARK REGIONAL PHYSICIAN PRACTICES LLC
- Doing business as
- CENTERPOINT FAMILY MEDICINE - WINCHESTER BOONESBORO ROAD
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 10, 2002
- Last certification
- Feb 17, 2026
- Ownership / control type
- 2C
- Most recent change of ownership
- Sep 15, 2015 (1 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 12, 2012 in DE
- Enrollment address
- 1520 Boonesboro Rd
Winchester, KY 40391-8816
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Direct Ownership Interest | Sep 1, 2015 | 100% |
| Pamela Kane |
Corporate Officer |
Aug 9, 2022 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Laura C Hinson |
Corporate Officer |
Mar 12, 2025 | |
| Lifepoint Hospitals Holdings LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 100% |
| Historic Lifepoint Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Sep 1, 2015 | 100% |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
| Charlotte E Lawrence |
Corporate Officer |
Jan 21, 2022 | |
| Elliott Brown |
Corporate Officer |
Apr 2, 2026 | |
| Klaus Michael Boel |
Corporate Officer |
Aug 19, 2024 | |
| W-2 Managing Employee | Aug 19, 2024 | ||
| Christopher J Monte |
Corporate Officer |
Jan 1, 2015 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120919000575 | KY | Part B Supplier - Clinic/Group Practice | 9739337569 |
Receives reassigned benefits from 102 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winchester, KY; Georgetown, KY; Lexington, KY; Mt Sterling, KY; Paris, KY; Stanton, KY |
| O20151113001121 | KY | Part a Provider - Rural Health Clinic | 9739337569 |
1 other NPI on this enrollment Practice locations: Winchester, KY |
National Provider Directory
- Tax ID family
- Clark Regional Physician Practices LLC
Locations
1520 Boonesboro Rd
Winchester, KY 40391
Phone (859) 744-0067
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1520 Boonesboro Rd
Winchester, KY 40391-8816
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names
- Centerpoint Family Medicine - Winchester Boonesboro Road
- Clark Clinic Family Medicine
Other providers in Winchester, KY
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices LLC
- Clark Regional Physician Practices, LLC
- Casey Lane Clark
- Magdalene Cooper Cloyd
- April Coldiron
All providers in Winchester, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.