NPIMap

Organization Active NPI

Kentucky Family Practice Inc

  • Rural Health Clinic/Center
  • London, KY
National Provider Identifier
1851054597
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KENTUCKY FAMILY PRACTICE INC
Practice address
195 Commercial Dr Ste 98
London, KY 40744-5200
Phone
(606) 878-1219
NPI assigned
Oct 19, 2021
Last updated
Oct 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Authorized official

Name
Eric Evans
Title
Owner
Phone
(606) 878-1219

Specialties & licenses 1

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

Addresses

Primary practice location

195 Commercial Dr Ste 98
London, KY 40744-5200

Mailing address

195 Commercial Dr Ste 98
London, KY 40744-5200
Phone (606) 878-1219

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211028000739 KY Part A Provider - Rural Health Clinic 4486042207 Practice locations: London, KY
O20230516001007 KY Part B Supplier - Clinic/Group Practice 4486042207 Receives reassigned benefits from 11 practitioners
Practice locations: London, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851054597. Details of each certification follow.

Rural health clinic certification: CCN B03892

Legal name
KENTUCKY FAMILY PRACTICE INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 8, 2022
Last certification
Mar 8, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Mar 17, 1995 in KY
Enrollment address
195 Commercial Dr
Ste 98
London, KY 40744-5200

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
18D2240664Kentucky Family Practice, Inc195 Commercial Drive Suite 98, London, KY 40744Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory

Locations

195 Commercial Dr
Ste 98
London, KY 40744
Phone (606) 878-1219

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Randy Matthew Brown Individual 5% Or Greater Direct Ownership InterestManaging Partner Apr 1, 2025 33.3%
Corporate OfficerManaging Partner Apr 1, 2025 33.3%
Eric J Evans Individual 5% Or Greater Direct Ownership InterestMember Apr 1, 2025 16.7%
Corporate OfficerMember Apr 1, 2025 16.7%
W-2 Managing EmployeeMember Apr 1, 2025 16.7%
Paul Andrews Individual 5% Or Greater Direct Ownership InterestCeo/Managing Partner Apr 1, 2025 33.3%
Corporate OfficerCeo/Managing Partner Apr 1, 2025 33.3%
Edward L Valentine Individual 5% Or Greater Direct Ownership InterestMember Apr 1, 2025 16.7%
Corporate OfficerMember Apr 1, 2025 16.7%
W-2 Managing EmployeeMember Sep 30, 2020 16.7%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1851054597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 COMMERCIAL DR STE 98",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407445200",
            "telephone_number": "606-878-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 COMMERCIAL DR STE 98",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407445200",
            "telephone_number": "606-878-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY FAMILY PRACTICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-878-1219"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.