SOUTHFORK MEDICAL CLINIC PLLC
NPI 1295718757
Specialist in Whitley City, KY

NPI Status: Active since November 29, 2005

Contact Information

71 MEDICAL LN
WHITLEY CITY, KY
ZIP 42653
Phone: (606) 376-7212
Fax: (606) 376-7216

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  • Organization
  • Specialist
  • Accepts Insurance
  • CLIA Number: 18D2291792
  • CLIA Cert. Type: Rural Health Clinic
  • CLIA Exp. Date: 10-15-2025

About SOUTHFORK MEDICAL CLINIC PLLC

This page provides the complete NPI Profile along with additional information for Southfork Medical Clinic Pllc, a provider established in Whitley City, Kentucky operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1295718757 assigned on November 2005. The practitioner's primary taxonomy code is 174400000X. The provider is registered as an organization and their NPI record was last updated 14 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Francis Pimentel Md (Medical Director)

NPI
1295718757
Provider Name
SOUTHFORK MEDICAL CLINIC PLLC
Entity Type
Organization
Location Address
71 MEDICAL LN WHITLEY CITY, KY 42653
Location Phone
(606) 376-7212
Location Fax
(606) 376-7216
Mailing Address
71 MEDICAL LN WHITLEY CITY, KY 42653
Mailing Phone
(606) 376-7212
Mailing Fax
(606) 376-7216
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-29-2005
Last Update Date
08-23-2011
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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

Specialist

Taxonomy Code
174400000X
Type
Other Service Providers
Taxonomy Description
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Complete Silver - EPO
  • Complete Silver + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Clear Gold - HMO
  • Clear Gold + Vision + Adult Dental - HMO
  • Clear Silver - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Central Bronze - HMO
  • Central Bronze + Vision + Adult Dental - HMO
  • Central Gold - HMO
  • Central Gold + Vision + Adult Dental - HMO
  • Clear Silver - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Clear Silver - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Everyday Gold - EPO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

FRANCIS PIMENTEL MD

Authorized Official Title
MEDICAL DIRECTOR
Authorized Official Phone
(606) 376-7212

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
183920MEDICARE OSCAR/CERTIFICATION (06)KY 
183920MEDICARE PIN (08)KY 
35001593MEDICAID (05)KY 
07396OTHER (01)KYMEDICARE B

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
18D2291792
Facility Type
Rural Health Clinic
Certificate Effective Date
October 16, 2023
Certificate Expiration Date
October 15, 2025
Laboratory Director
DR. STEVEN J. THOMPSON
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Southfork Medical Clinic Pllc 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.

Reviews for SOUTHFORK MEDICAL CLINIC PLLC

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1295718757
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2218514116710
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 8 + 5 + 1 + 4 + 1 + 1 + 6 + 7 + 1 + 0 + 24 = 63
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 63 = 77

The NPI number 1295718757 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 8 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1255314159 TAMMIE L EMERSON-JOHNSON FNP
Individual
Nurse Practitioner71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1982687893 STEPHANIE CASH-SMITH FNP
Individual
Nurse Practitioner71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1487637963 MERRILL WINCHESTER MD
Individual
Specialist71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1942593629SANDSTONE COMMUNITY CARE, LLC
Organization
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 310-9737
1225258130MRS. MELISSA BETH CHENG MSN, FNP
Individual
Nurse Practitioner71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1851613228 TERRY LAWSON APRN
Individual
Nurse Practitioner71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1861811093 CARL DON COFFEY APRN
Individual
Nurse Practitioner71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212
1386433100MRS. TABITHA LAUREN COX
Individual
Nurse Practitioner (Family)71 MEDICAL LN
WHITLEY CITY, KY 42653
(606) 376-7212

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1295718757, enumerated in the NPI registry as an "organization" on November 29, 2005

The provider is located at 71 Medical Ln Whitley City, Ky 42653 and the phone number is (606) 376-7212

This medical organization specializes in Specialist with taxonomy code 174400000X

The provider might be accepting Accepts: Ambetter from Home State Health, Ambetter Health,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The provider's CLIA number is 18D2291792 for a "rural health clinic" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued 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..

This NPI record was last updated on November 29, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.