NPIMap

Organization Active NPI

Lake Cumberland Physician Practices, LLC

Doing business as Lake Cumberland Urology Associates

  • Urology Physician
  • Somerset, KY
National Provider Identifier
1982073813
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC
Doing business as
Lake Cumberland Urology Associates
Practice address
30 Medpark Square
Suite 1
Somerset, KY 42503-1709
Phone
(606) 451-0485
Fax
(606) 451-0229
NPI assigned
Sep 22, 2015
Last updated
Sep 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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

Authorized official

Name
Sara Miller
Title
Director
Phone
(615) 920-7514

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

30 Medpark Square
Suite 1
Somerset, KY 42503-1709

Mailing address

PO Box 719
Somerset, KY 42502-0719
Phone (606) 451-0485

Other names 1

  • Lake Cumberland Urology Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090504000210 KY Part B Supplier - Clinic/Group Practice 2567510464 Receives reassigned benefits from 87 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerset, KY; Whitley City, KY; Springfield, KY; London, KY; Russell Springs, KY; Harlan, KY

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
18D0326735Lake Cumberland Urology Associates30 Medpark Drive, Suite 1, Somerset, KY 42503Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Lake Cumberland Physician Practices LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1982073813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425020719",
            "telephone_number": "606-451-0485",
            "fax_number": "606-451-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEDPARK SQUARE",
            "address_2": "SUITE 1",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425031709",
            "telephone_number": "606-451-0485",
            "fax_number": "606-451-0229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2017-09-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-920-7514"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Cumberland Urology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.