MAIN STREET MEDICAL CLINIC
NPI 1952180408
Nurse Practitioner - Family in Grayson, KY
About Main Street Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MAIN STREET MEDICAL CLINIC (NPI 1952180408) is a healthcare organization registered as a family in Grayson, Kentucky and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through August 30, 2027 and lists Stacy Holley, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 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)
Main Street Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Main Street Medical Clinic, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 18D2288813
Main Street Medical Clinic · Grayson, KYFrequently 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 Main Street Medical Clinic's NPI number?
The NPI number for Main Street Medical Clinic is 1952180408. It was assigned to this organization in the NPPES registry on September 25, 2023.
Where is Main Street Medical Clinic located?
Main Street Medical Clinic is located at 107 E Main St, Grayson, KY 41143. The listed phone number is (606) 474-0244.
What is Main Street Medical Clinic's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Main Street Medical Clinic enrolled in Medicare?
Yes. Main Street Medical Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Main Street Medical Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Main Street Medical Clinic. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Main Street Medical Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 18D2288813) is associated with this NPI, valid through August 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Main Street Medical Clinic accept?
Health plans from Anthem Blue Cross and Blue Shield list Main Street Medical Clinic 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 Main Street Medical Clinic was last updated on September 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Main Street Medical Clinic · NPI 1952180408
Family organization in Grayson, Kentucky. Organization record, active in the CMS NPPES registry since September 25, 2023.
## Identity
- **NPI:** 1952180408 (Entity type: Organization)
- **Enumerated:** September 25, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Stacy Holley, OWNER
## Practice location
- **Address:** 107 E MAIN ST, Grayson, KY 41143-1301
- **Phone:** (606) 474-0244 · **Fax:** (606) 474-0412
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 25, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1952180408) · Data from the CMS NPPES public registry.