NPIMap

Organization Active NPI

Pinelake Physician Practice, LLC

Doing business as Mayfield General Surgery Associates

  • Surgery Physician
  • Mayfield, KY
National Provider Identifier
1972738839
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PINELAKE PHYSICIAN PRACTICE, LLC
Doing business as
Mayfield General Surgery Associates
Practice address
1111 Medical Center Cir
Mayfield, KY 42066-1194
Phone
(270) 251-4547
Fax
(270) 251-4546
NPI assigned
May 21, 2009
Last updated
Oct 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Authorized official

Name
Mr. Thomas Weiss
Title
President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

1111 Medical Center Cir
Mayfield, KY 42066-1194

Mailing address

1111 Medical Center Cir
Mayfield, KY 42066-1194
Phone (270) 251-4547

Other names 1

  • Mayfield General Surgery Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115001094 KY Part B Supplier - Clinic/Group Practice 6800797507 Receives reassigned benefits from 71 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benton, KY; Paducah, KY; Mayfield, KY; Hickman, KY; Fulton, KY; Clinton, KY

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1972738839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER CIR",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420661194",
            "telephone_number": "270-251-4547",
            "fax_number": "270-251-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER CIR",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420661194",
            "telephone_number": "270-251-4547",
            "fax_number": "270-251-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELAKE PHYSICIAN PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-21",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayfield General Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayfield, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.