Sebree Medical Group

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SEBREE MEDICAL GROUP

Practice address

7139 State Route 56 E
Sebree, KY 42455-2136

Phone

(270) 318-5088

Fax

(270) 318-3131

NPI assigned

Nov 8, 2022

Last updated

Nov 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lesley Kyle Bow, MDNPI 1356592968

Title

Ceo

Phone

(407) 456-4591

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902514904. Details of each certification follow.

• CCN B03924 Rural health clinic · Active · Details

Rural health clinic certification: CCN B03924

Legal name

SEBREE MEDICAL GROUP

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 15, 2023

Last certification

Jun 15, 2023

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Nov 8, 2022 in KY

Enrollment address

7139 State Route 56 E
Sebree, KY 42455-2136

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Lesley Kyle Bow, MD

  • Pediatrics Physician
  • Pikeville, KY
  • NPI 1356592968

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 3

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.

• Lesley Kyle Bow, MD

  • Pediatrics Physician
  • Pikeville, KY
  • NPI 1356592968
  Medicare reassignment NPD Authorized official
• Joy Goben, APRN

  • Family Nurse Practitioner
  • Sebree, KY
  • NPI 1649785759
  Medicare reassignment NPD
• Jeremy D. Luckett, M.D.

  • Internal Medicine Physician
  • Owensboro, KY
  • NPI 1770748667
  Medicare reassignment NPD

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1902514904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180",
            "city": "SEBREE",
            "state": "KY",
            "postal_code": "424550180",
            "telephone_number": "270-318-5088",
            "fax_number": "270-318-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7139 STATE ROUTE 56 E",
            "city": "SEBREE",
            "state": "KY",
            "postal_code": "424552136",
            "telephone_number": "270-318-5088",
            "fax_number": "270-318-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEBREE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "BOW",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-456-4591",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Renee Rager
• Redbanks Colonial Terrace Inc.
• Sea Breeze Seven, Inc.
• Sebree Clinic, LLC (Connie Skinner ARNP)
• Sebree Medical Center
• Connie J. Skinner, ARNP
• Teen Challenge of Florida, Inc.

• Rural Health Clinic/Center in Sebree, KY
• Providers in Sebree, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.

Verify at the official NPI Registry.