JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC
NPI 1205494085
Clinic/Center - Rural Health in Hickman, KY
NPI Status: Active since June 05, 2019
Contact Information
2003 S 7TH ST
HICKMAN, KY
ZIP 42050
Phone: (270) 236-3337
Fax: (270) 236-3340
- Organization
- Clinic/Center
- Rural Health
- CLIA Number: 18D2106420
- CLIA Cert. Type: Rural Health Clinic
- CLIA Exp. Date: 12-16-2027
About JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC
This page provides the complete NPI Profile along with additional information for Jackson Purchase Primary Care Hickman Clinic, a primary care provider established in Hickman, Kentucky operating as a Clinic/center, focusing in rural health . The healthcare provider is registered in the NPI registry with number 1205494085 assigned on June 2019. The practitioner's primary taxonomy code is 261QR1300X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's is doing business as Jackson Purchase Primary Care Hickman Clinic. The authorized official of this NPI record is Terrance K. Dillon (Assistant Secretary)
- NPI
- 1205494085
- Provider Legal Name
- PINELAKE PHYSICIAN PRACTICE LLC
- Other Organization Name
- JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2003 S 7TH ST HICKMAN, KY 42050
- Location Phone
- (270) 236-3337
- Location Fax
- (270) 236-3340
- Mailing Address
- 330 SEVEN SPRINGS WAY BRENTWOOD, TN 37027
- Mailing Phone
- (615) 920-7780
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-05-2019
- Last Update Date
- 08-24-2022
- Code Navigator
A primary care provider (PCP) like Jackson Purchase Primary Care Hickman Clinic sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rural Health
- Taxonomy Code
- 261QR1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 18D2106420
- Facility Type
- Rural Health Clinic
- Certificate Effective Date
- December 17, 2025
- Certificate Expiration Date
- December 16, 2027
- Laboratory Director
- MS. BRANDI STACY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Jackson Purchase Primary Care Hickman Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1205494085, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 65 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 8 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1205494085, enumerated as an "organization" on June 05, 2019.
The provider is located at 2003 S 7TH ST HICKMAN, KY 42050 and the phone number is (270) 236-3337.
Clinic/Center with taxonomy code 261QR1300X and a focus in Rural Health.
