NPIMap

Organization Active NPI

Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
National Provider Identifier
1841900347
Registry record updated Nov 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PINELAKE PHYSICIAN PRACTICE, LLC
Practice address
1029 Medical Center Cir Ste 204
Mayfield, KY 42066-1189
Phone
(270) 251-4545
NPI assigned
Nov 25, 2022
Last updated
Nov 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2022

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

Authorized official

Name
Charlotte Lawrence
Title
Assistant Corporate Secretary
Phone
(615) 920-7688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1029 Medical Center Cir Ste 204
Mayfield, KY 42066-1189

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115001094 KY Part B Supplier - Clinic/Group Practice 6800797507 Receives reassigned benefits from 71 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benton, KY; Paducah, KY; Mayfield, KY; Hickman, KY; Fulton, KY; Clinton, KY
O20230125002844 KY Part A Provider - Rural Health Clinic 6800797507 Practice locations: Mayfield, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841900347. Details of each certification follow.

Rural health clinic certification: CCN B03926

Legal name
PINELAKE PHYSICIAN PRACTICE LLC
Doing business as
JACKSON PURCHASE PRIMARY CARE-PURCHASE CONVENIENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 7, 2023
Last certification
Jul 7, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Nov 19, 1988 in KY
Enrollment address
1029 Medical Center Cir
Ste 202
Mayfield, KY 42066-1189

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0923105Jackson Purchase Primary Care - Convenient Care1029 Medical Center Circle, Suite 202, Mayfield, KY 42066Certificate of waiverNov 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Dale W Kesl DO9 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

619 Old Symsonia Rd
Benton, KY 42025
Phone (270) 527-0880

380 S Washington St
Ste 200
Clinton, KY 42031
Phone (270) 653-0220

309 Main St
Fulton, KY 42041
Phone (270) 472-1108

1029 Medical Center Cir
#200A
Mayfield, KY 42066
Phone (270) 251-4545

1029 Medical Center Cir
Ste 204
Mayfield, KY 42066
Phone (270) 251-4545

1029 Medical Center Cir
Ste 306
Mayfield, KY 42066
Phone (270) 251-4575

1029 Medical Center Cir
Ste 401
Mayfield, KY 42066
Phone (270) 251-4590

1111 Medical Center Cir
Mayfield, KY 42066
Phone (270) 247-8100

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lifepoint Holdings 2 LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2023 100%
Pamela Kane Individual Corporate OfficerVice President Jan 1, 2023
Lifepoint of Kentucky LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
DSB Acquisition LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2023 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Hospitals Holdings LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Historic Lifepoint Hospitals, LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2023 100%
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2023 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Jan 1, 2023
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Klaus Michael Boel Individual Corporate OfficerPresident Aug 19, 2024
W-2 Managing Employee Aug 19, 2024
Christopher J Monte Individual Corporate OfficerVice President Jan 1, 2023
Legacy Lifepoint Health LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2023 100%

Facilities with the same owner 193

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Bourbon Community Hospital LLC

    dba Bourbon Community Hospital

    • Rural Acute Care Hospital
    • Paris, KY
    • NPI 1427132158

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Bourbon Community Hospital LLC

    dba Bourbon Community Hospital

    • Psychiatric Hospital Unit
    • Paris, KY
    • NPI 1902089865

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Bourbon Physician Practice LLC

    dba Bluegrass Family Clinic

    • Rural Health Clinic/Center
    • Paris, KY
    • NPI 1962111716

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Family Medicine - Mt. Sterling

    • Rural Health Clinic/Center
    • Mt Sterling, KY
    • NPI 1780356253

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Family Medicine - Winchester Boonesboro Road

    • Rural Health Clinic/Center
    • Winchester, KY
    • NPI 1831852771

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Clark Regional Physician Practices LLC

    dba Centerpoint Primary Care - Winchester

    • Rural Health Clinic/Center
    • Winchester, KY
    • NPI 1841953783

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Fleming Medical Center LLC

    dba Fleming County Hospital

    • Critical Access Hospital
    • Flemingsburg, KY
    • NPI 1881726347

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Georgetown Community Hospital LLC

    dba Gerogetown Community Hospital

    • Rural Acute Care Hospital
    • Georgetown, KY
    • NPI 1326107319

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Kentucky Hospital, LLC

    dba Clark Regional Medical Center

    • General Acute Care Hospital
    • Winchester, KY
    • NPI 1811213994

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Kentucky in-Home Partner-I, LLC

    dba Lifeline of Jackson Purchase Home Health

    • Home Health Agency
    • Mayfield, KY
    • NPI 1508394594

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Kentucky Mso LLC

    dba Centerpoint Family Medicine - Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, KY
    • NPI 1922860758

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint of Kentucky LLC

    CMS ownership
  • Lake Cumberland Regional Hospital LLC

    dba Lake Cumberland Medical Associates

    • Rural Health Clinic/Center
    • Somerset, KY
    • NPI 1023155462

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
View all 193

Practitioners & affiliated clinicians

Practitioners 73

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.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1669334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669334400000",
    "number": "1841900347",
    "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": "370275098",
            "telephone_number": "615-920-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 MEDICAL CENTER CIR STE 204",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420661189",
            "telephone_number": "270-251-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELAKE PHYSICIAN PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-25",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "ASSISTANT CORPORATE SECRETARY",
        "authorized_official_telephone_number": "615-920-7688"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayfield, KY

Sources for this page

Verify at the official NPI Registry.