NPIMap

Organization Active NPI

Compassion Pediatrics of Wayland

  • Rural Health Clinic/Center
  • Wayland, KY
National Provider Identifier
1922754290
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMPASSION PEDIATRICS OF WAYLAND
Practice address
2643 King Kelly Coleman Hwy
Wayland, KY 41666
Phone
(606) 230-2255
Fax
(606) 437-3001
NPI assigned
Feb 25, 2022
Last updated
May 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

2643 King Kelly Coleman Hwy
Wayland, KY 41666

Mailing address

PO Box 293
Wayland, KY 41666-0293
Phone (606) 230-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220620000365 KY Part A Provider - Rural Health Clinic 3476932617 Practice locations: Wayland, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922754290. Details of each certification follow.

Rural health clinic certification: CCN B03897

Legal name
COMPASSION PEDIATRICS OF WAYLAND
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2022
Last certification
Dec 21, 2022
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Feb 3, 2022 in FL
Enrollment address
2643 King Kelly Coleman Hwy
Wayland, KY 41666

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
18D2257601Compassion Pediatrics of Wayland LLC2643 King Kelly Coleman Hwy, Wayland, KY 41666Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Lesley Kyle Bow Individual 5% Or Greater Direct Ownership InterestCeo Feb 3, 2022 100%
Corporate OfficerCeo Feb 3, 2022 100%
Operational/Managerial ControlCeo Feb 3, 2022 100%

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 & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1922754290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 293",
            "city": "WAYLAND",
            "state": "KY",
            "postal_code": "416660293",
            "telephone_number": "606-230-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2643 KING KELLY COLEMAN HWY",
            "city": "WAYLAND",
            "state": "KY",
            "postal_code": "41666",
            "telephone_number": "606-230-2255",
            "fax_number": "606-437-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASSION PEDIATRICS OF WAYLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayland, KY

Sources for this page

Verify at the official NPI Registry.