NPIMap

Organization Active NPI

Rose Bowling, LLC

  • Rural Health Clinic/Center
  • Richmond, KY
National Provider Identifier
1891799177
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900185 Issued in KY
Legal business name
ROSE BOWLING, LLC
Practice address
2161 Lexington Rd
Richmond, KY 40475-7952
Phone
(859) 626-7794
Fax
(859) 626-7764
NPI assigned
Jun 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
Ms. Reba M. Bowling
Title
Owner Ceo
Phone
(859) 626-7794

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900185 KY Primary

Addresses

Primary practice location

2161 Lexington Rd
Richmond, KY 40475-7952

Mailing address

2161 Lexington Rd
First Floor, Suite 5
Richmond, KY 40475-7952
Phone (859) 626-7794

Other identifiers 1

IdentifierTypeStateIssuer
35001775MedicaidKY

Other names 1

  • Madison Family Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040820000358 KY Part B Supplier - Clinic/Group Practice 5698749216 Receives reassigned benefits from 3 practitioners
Practice locations: Richmond, KY
O20040910000988 KY Part A Provider - Rural Health Clinic 5698749216 Practice locations: Richmond, KY

Rural health clinic certification: CCN 183935

Legal name
ROSE BOWLING, LLC
Doing business as
MADISON FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 20, 2005
Last certification
Oct 26, 2015
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jan 15, 2004 in KY
Enrollment address
2161 Lexington Road
1St Floor Suite 5
Richmond, KY 40475-7952

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
18D1028469Madison Family Clinic2161 Lexington Road 1St FL Ste 5, Richmond, KY 40475Provider-performed microscopyJul 25, 2028

National Provider Directory

National Provider Directory

Locations

98 River St
Clay City, KY 40312
Phone (606) 663-7788

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Elbert Bowling Individual W-2 Managing Employee Sep 15, 2004
Reba Bowling Individual 5% Or Greater Direct Ownership InterestOwner/Ceo Jan 15, 2004 100%
W-2 Managing EmployeeOwner/Ceo Jan 15, 2004

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1891799177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2161 LEXINGTON RD",
            "address_2": "FIRST FLOOR, SUITE 5",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404757952",
            "telephone_number": "859-626-7794",
            "fax_number": "859-626-7764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2161 LEXINGTON RD",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404757952",
            "telephone_number": "859-626-7794",
            "fax_number": "859-626-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE BOWLING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-02",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "REBA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "859-626-7794",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001775",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, KY

Sources for this page

Verify at the official NPI Registry.