PINELAKE PHYSICIAN PRACTICE, LLC
NPI 1295960532
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 1295960532) is a healthcare organization registered as a rural health in Mayfield, Kentucky and active in the NPI registry since May 2009. The organization lists Charlotte Lawrence, Secretary, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation 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).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
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, 3 practice at this address and 27 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 71Mayfield, KY 42066
Mayfield, KY 42066
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 Pinelake Physician Practice, LLC's NPI number?
The NPI number for Pinelake Physician Practice, LLC is 1295960532. It was assigned to this organization in the NPPES registry on May 15, 2009.
Where is Pinelake Physician Practice, LLC located?
Pinelake Physician Practice, LLC is located at 1111 Medical Center Cir, Mayfield, KY 42066. The listed phone number is (270) 251-4543.
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.
When is Pinelake Physician Practice, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Kentucky, Rural Health Clinic) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
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, 3 practice at this address and 27 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Pinelake Physician Practice, LLC accept?
Health plans from Anthem Blue Cross and Blue Shield list Pinelake Physician Practice, LLC 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 Pinelake Physician Practice, LLC was last updated on July 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 1295960532
Rural Health organization in Mayfield, Kentucky. Organization record, active in the CMS NPPES registry since May 15, 2009.
## Identity
- **NPI:** 1295960532 (Entity type: Organization)
- **Enumerated:** May 15, 2009
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Organization subpart:** No
- **Authorized official:** Charlotte Lawrence, SECRETARY
## Practice location
- **Address:** 1111 MEDICAL CENTER CIR, Mayfield, KY 42066-1194
- **Phone:** (270) 251-4543 · **Fax:** (270) 251-4544
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Part A, Kentucky, Rural Health Clinic) · CMS Revalidation Due Date List, October 2026 release
- **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); 3 practice at this address and 27 within 10 miles; [full list](https://npiprofile.com/npi/1295960532/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 16, 2026
- **Other identifiers:** Other 000000618910 (KY); Medicaid 7100335050 (KY)
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Source: [NPI Profile](https://npiprofile.com/npi/1295960532) · Data from the CMS NPPES public registry.