PINELAKE PHYSICIAN PRACTICE LLC
NPI 1093609612
Clinic/Center - Rural Health in Mayfield, KY
About Pinelake Physician Practice Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PINELAKE PHYSICIAN PRACTICE LLC (NPI 1093609612), doing business as Jackson Purchase Primary Care - Southside Clinic, is a healthcare organization registered as a rural health in Mayfield, Kentucky and active in the NPI registry since June 2025. The organization lists Charlotte Lawrence, Secretary, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pinelake Physician Practice Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
71Medicare enrollment records show 71 clinicians reassign Medicare billing to Pinelake Physician Practice LLC, which bills Medicare for the services they deliver. Of these, 27 practice within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 21
Nearest to this location (20)
See all 71Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Pinelake Physician Practice LLC's NPI number?
The NPI number for Pinelake Physician Practice LLC is 1093609612. It was assigned to this organization in the NPPES registry on June 6, 2025. The provider is doing business as Jackson Purchase Primary Care - Southside Clinic.
Where is Pinelake Physician Practice LLC located?
Pinelake Physician Practice LLC is located at 1206 Paris Rd Ste B, Mayfield, KY 42066. The listed phone number is (270) 804-7160.
What is Pinelake Physician Practice LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Pinelake Physician Practice LLC enrolled in Medicare?
Yes. Pinelake Physician Practice LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pinelake Physician Practice LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 71 clinicians in 21 Medicare specialties reassign their Medicare billing to Pinelake Physician Practice LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (29), Cardiovascular Disease (Cardiology) (6) and Obstetrics/Gynecology (5). Of these, 27 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Pinelake Physician Practice LLC was last updated on June 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Pinelake Physician Practice Llc · NPI 1093609612
Rural Health organization in Mayfield, Kentucky. Organization record, active in the CMS NPPES registry since June 6, 2025.
## Identity
- **NPI:** 1093609612 (Entity type: Organization)
- **Enumerated:** June 6, 2025
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Also known as:** Jackson Purchase Primary Care - Southside Clinic (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Charlotte Lawrence, SECRETARY
## Practice location
- **Address:** 1206 PARIS RD STE B, Mayfield, KY 42066-4989
- **Phone:** (270) 804-7160
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 71 clinicians in 21 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (29), Cardiovascular Disease (Cardiology) (6), Obstetrics/Gynecology (5); 27 practice within 10 miles; [full list](https://npiprofile.com/npi/1093609612/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 6, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1093609612) · Data from the CMS NPPES public registry.