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
- 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
- Code Navigator
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
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.
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 |
|---|---|---|---|
| 183920 | MEDICARE OSCAR/CERTIFICATION (06) | KY | |
| 183920 | MEDICARE PIN (08) | KY | |
| 35001593 | MEDICAID (05) | KY | |
| 07396 | OTHER (01) | KY | MEDICARE 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. | |||||||||
| 1 | 2 | 9 | 5 | 7 | 1 | 8 | 7 | 5 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 18 | 5 | 14 | 1 | 16 | 7 | 10 | |
| 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 = 7 | 7 | ||||||||
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 Practitioner | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1982687893 | STEPHANIE CASH-SMITH FNP Individual | Nurse Practitioner | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1487637963 | MERRILL WINCHESTER MD Individual | Specialist | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1942593629 | SANDSTONE COMMUNITY CARE, LLC Organization | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 310-9737 |
| 1225258130 | MRS. MELISSA BETH CHENG MSN, FNP Individual | Nurse Practitioner | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1851613228 | TERRY LAWSON APRN Individual | Nurse Practitioner | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1861811093 | CARL DON COFFEY APRN Individual | Nurse Practitioner | 71 MEDICAL LN WHITLEY CITY, KY 42653 (606) 376-7212 |
| 1386433100 | MRS. 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].
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