SOUTHFORK MEDICAL CLINIC PLLC
NPI 1205616265
Clinic/Center - Rural Health in Whitley City, KY
About Southfork Medical Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHFORK MEDICAL CLINIC PLLC (NPI 1205616265), doing business as South Fork Clinic Pllc, is a healthcare organization registered as a rural health in Whitley City, Kentucky and active in the NPI registry since October 2023. The organization lists Virginia Ann Correll, Credentialing, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southfork Medical Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Southfork Medical Clinic PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
Source: 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 Southfork Medical Clinic PLLC's NPI number?
The NPI number for Southfork Medical Clinic PLLC is 1205616265. It was assigned to this organization in the NPPES registry on October 5, 2023. The provider is doing business as South Fork Clinic PLLC.
Where is Southfork Medical Clinic PLLC located?
Southfork Medical Clinic PLLC is located at 57 Medical Lane, Whitley City, KY 42653. The listed phone number is (606) 376-7211.
What is Southfork Medical Clinic PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Southfork Medical Clinic PLLC enrolled in Medicare?
Yes. Southfork Medical Clinic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southfork Medical Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Southfork Medical Clinic PLLC. 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 (6) and Certified Clinical Nurse Specialist (CNS) (1). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Southfork Medical Clinic PLLC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter of Tennessee list Southfork Medical Clinic PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southfork Medical Clinic PLLC was last updated on November 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Southfork Medical Clinic Pllc · NPI 1205616265
Rural Health organization in Whitley City, Kentucky. Organization record, active in the CMS NPPES registry since October 5, 2023.
## Identity
- **NPI:** 1205616265 (Entity type: Organization)
- **Enumerated:** October 5, 2023
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Also known as:** SOUTH FORK CLINIC PLLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Virginia Correll, CREDENTIALING
## Practice location
- **Address:** 57 MEDICAL LANE, Whitley City, KY 42653
- **Phone:** (606) 376-7211 · **Fax:** (606) 376-9219
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (6), Certified Clinical Nurse Specialist (CNS) (1); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 25, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1205616265) · Data from the CMS NPPES public registry.