Active NPI
Hospice of Lake Cumberland, Inc.
- Community Based Hospice Care Agency
- Somerset, KY
National Provider Identifier
1851494124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- HOSPICE OF LAKE CUMBERLAND, INC.
- Practice address
- 100 Parkway Dr
Somerset, KY 42503-3450 - Phone
- (606) 679-4389
- Fax
- (606) 679-2971
- NPI assigned
- Sep 5, 2006
- Last updated
- Jun 16, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Brian J Davis
- Title
- Director of Operations
- Phone
- (606) 679-4389
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | KY | Primary | |
| Hospice and Palliative Medicine (Family Medicine) Physician | 207QH0002X | KY |
Addresses
Primary practice location
100 Parkway Dr
Somerset, KY 42503-3450
Mailing address
100 Parkway Drive
Somerset, KY 42503
Phone (606) 679-4389
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44100014 | Medicaid | KY |
Other names 2
- Hospice of Lake Cumberland
- Palliative Care of Lake Cumberland
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 2
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1851494124. Details of each certification follow.
Hospice certification: CCN 181510
- Legal name
- HOSPICE OF LAKE CUMBERLAND INC
- Doing business as
- SOMERSET PULASKI COUNTY COMMUNITY HOSPICE INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 3, 1988
- Last certification
- Jan 26, 2018
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation
- Incorporated
- Jul 23, 1984 in KY
- Enrollment address
- 100 Parkway Dr
Somerset, KY 42503-3450
Care Compare: Hospice
Medicare Care Compare- Listed as
- Hospice of Lake Cumberland
- Ownership
- Non-Profit
- Certified
- Feb 3, 1988
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2052234 | Hospice of Lake Cumberland | Certificate of waiver | Jan 7, 2027 |
National Provider Directory
National Provider DirectoryLocations
1215 N Main St
Ste 10
Monticello, KY 42633
Phone (606) 343-5011
1219 N Main St
Ste 4
Monticello, KY 42633
Phone (606) 343-5011
100 Parkway Dr
Somerset, KY 42503
Phone (606) 679-4389
305 Langdon St
Fl 4R
Somerset, KY 42503
Ownership & related parties
All disclosed owners & managing parties 24
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Brian Davis | Corporate Director | Jul 5, 2011 | |
| W-2 Managing Employee | Jul 5, 2011 | ||
| Charlene Harris | Corporate Director | Jan 1, 2013 | |
| Donald Moss | Corporate Director | Jan 22, 2000 | |
| Sheila Hickey | Corporate Director | Jan 22, 2007 | |
| Geraldine Thomas | Corporate Director | Jan 22, 2007 | |
| Colleen Bivens | Corporate Director | Jan 1, 1994 | |
| Danny Clark | Corporate Director | Jan 22, 2007 | |
| Leslie Hammer | Corporate Director | Feb 20, 2008 | |
| Euretha D Godby | Corporate Director | Apr 1, 2012 | |
| W-2 Managing Employee | Sep 25, 2014 | ||
| Elaine Wilson | Corporate Director | Jan 1, 1989 | |
| Mark Thomas Brenzel | Corporate Director | Jan 1, 2014 | |
| Hilda Legg | Corporate Director | Jan 1, 2010 | |
| Pamela Godby | Corporate Director | Jan 22, 2007 | |
| Elizabeth Hall | Corporate Director | Jan 22, 2007 | |
| William Hill | Corporate Director | Jan 1, 2008 | |
| Brian Jaggers | Corporate Director | Jan 1, 2014 | |
| Glenna Hayford | Corporate Director | Jan 1, 1984 | |
| Brooke Whitis | Corporate Director | Jan 1, 2014 | |
| John Gillum | Corporate Director | Jan 22, 2007 | |
| Christie Adams | Corporate Director | Jan 1, 2011 | |
| Diane Kiser | Corporate Director | Jan 22, 2007 | |
| Vincent Cheshire | Corporate Director | Jan 1, 1984 | |
| Renny Smith | Corporate Director | Jan 1, 2011 | |
| Sheryl E Polk | Corporate Director | Jan 1, 1999 |
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 7
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.
-
- Family Nurse Practitioner
- Somerset, KY
- NPI 1871029181
-
- Family Nurse Practitioner
- Monticello, KY
- NPI 1962927004
-
- Family Nurse Practitioner
- Somerset, KY
- NPI 1831798511
-
- Family Medicine Physician
- Monticello, KY
- NPI 1720148356
-
- Family Medicine Physician
- Somerset, KY
- NPI 1124021563
-
- Nurse Practitioner
- Monticello, KY
- NPI 1578554978
-
- Family Medicine Physician
- Monticello, KY
- NPI 1467443879
Affiliated clinicians 19
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529107200000",
"number": "1851494124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 PARKWAY DRIVE",
"city": "SOMERSET",
"state": "KY",
"postal_code": "42503",
"telephone_number": "606-679-4389",
"fax_number": "606-679-2971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PARKWAY DR",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425033450",
"telephone_number": "606-679-4389",
"fax_number": "606-679-2971"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOSPICE OF LAKE CUMBERLAND, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-05",
"last_updated": "2018-06-16",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "BRIAN",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "606-679-4389",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "KY",
"license": null,
"primary": true
},
{
"code": "207QH0002X",
"taxonomy_group": "",
"desc": "Family Medicine, Hospice and Palliative Medicine",
"state": "KY",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44100014",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Hospice of Lake Cumberland",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Palliative Care of Lake Cumberland",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Palliative Care of Lake Cumberland",
"code": "5",
"type": "Other Name"
}
]
}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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.