Pinelake Physician Practice, LLC - Medicare Primary Care in Mayfield, KY

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Pinelake Physician Practice, LLC is a medicare enrolled primary clinic (Clinic/center - Rural Health) in Mayfield, Kentucky. The current practice location for Pinelake Physician Practice, LLC is 1111 Medical Center Cir, Mayfield, Kentucky. For appointments, you can reach them via phone at (270) 251-4543. The mailing address for Pinelake Physician Practice, LLC is 330 Seven Springs Way, Atten: Provider Enrollment, Brentwood, Tennessee and phone number is (615) 920-7192.

Pinelake Physician Practice, LLC is licensed to practice in NU (license number ). The clinic also participates in the medicare program and its NPI number is 1295960532. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (270) 251-4543.

Contact Information

Pinelake Physician Practice, LLC
1111 Medical Center Cir
Mayfield
KY 42066-1194
(270) 251-4543
(270) 251-4544

Map and Direction


Primary Care Clinic Profile

Full NamePinelake Physician Practice, LLC
SpecialityClinic/Center
Location1111 Medical Center Cir, Mayfield, Kentucky
Authorized Official Name and PositionCharlotte Lawrence (SECRETARY)
Authorized Official Contact6159207688
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Pinelake Physician Practice, LLC
330 Seven Springs Way
Atten: Provider Enrollment
Brentwood
TN 37027-5098

Ph: (615) 920-7192		Pinelake Physician Practice, LLC
1111 Medical Center Cir
Mayfield
KY 42066-1194

Ph: (270) 251-4543

NPI Details:

NPI Number1295960532
Provider Enumeration Date05/15/2009
Last Update Date07/16/2026
Certification Date07/16/2026

Medicare PECOS Information:

Medicare PECOS PAC ID6800797507
Medicare Enrollment IDO20040115001094

Medical Identifiers

Medical identifiers for Pinelake Physician Practice, LLC such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1295960532NPI-NPPES
000000618910OtherKYANTHEM
7100335050MedicaidKY

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QR1300XClinic/center - Rural Health (NU)Primary
207Q00000XFamily Medicine (NU)Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Pinelake Physician Practice, LLC acts as a billing entity for following providers:
Provider NameLalchand Goyal
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1154328805
PECOS PAC ID: 9032021381
Enrollment ID: I20040507000322
Provider NameTyrone Lee Daniels
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1043264393
PECOS PAC ID: 4981517166
Enrollment ID: I20040608001374
Provider NameRuben Cuadrado
Provider TypePractitioner - Gastroenterology
Provider IdentifiersNPI Number: 1902868532
PECOS PAC ID: 5395728075
Enrollment ID: I20040611001492
Provider NameTrey Edward Early
Provider TypePractitioner - Certified Registered Nurse Anesthetist (crna)
Provider IdentifiersNPI Number: 1508806183
PECOS PAC ID: 1850365172
Enrollment ID: I20040823001213
Provider NameTanya M Hayes
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1679576342
PECOS PAC ID: 2961309570
Enrollment ID: I20050223000551
Provider NamePhilip G Hunt
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1629172234
PECOS PAC ID: 7214977388
Enrollment ID: I20050509000224
Provider NameTanna S Vaughan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1073606539
PECOS PAC ID: 2567402654
Enrollment ID: I20050509000342
Provider NameJorge M Cardenas
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1093702128
PECOS PAC ID: 7113917568
Enrollment ID: I20050629001108
Provider NameChristopher D Dobrose
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1871564666
PECOS PAC ID: 8325079783
Enrollment ID: I20050825000236
Provider NameJonathan a Wynstra
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1235132960
PECOS PAC ID: 5496778730
Enrollment ID: I20060112000420
Provider NameAllie L Alexander Lusk
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1831139054
PECOS PAC ID: 0648273540
Enrollment ID: I20060815000193
Provider NameMatthew E Price
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1528118551
PECOS PAC ID: 3971505637
Enrollment ID: I20070208000398
Provider NameJaime L Rhodes
Provider TypePractitioner - Certified Clinical Nurse Specialist (cns)
Provider IdentifiersNPI Number: 1962582833
PECOS PAC ID: 5294834057
Enrollment ID: I20070706000315
Provider NamePatricia M Williams
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1952304891
PECOS PAC ID: 4385735265
Enrollment ID: I20070807000292
Provider NameJames G Whiteley
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1659326247
PECOS PAC ID: 6406937507
Enrollment ID: I20080115000391
Provider NameElias Pitaras
Provider TypePractitioner - Nephrology
Provider IdentifiersNPI Number: 1104096239
PECOS PAC ID: 2062582778
Enrollment ID: I20080607000073
Provider NameAbid Hussain
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1164620340
PECOS PAC ID: 4284709973
Enrollment ID: I20080814000313
Provider NameMuhammad Sajid
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1801825500
PECOS PAC ID: 3971537317
Enrollment ID: I20080820000532
Provider NameAnita Torok
Provider TypePractitioner - Gastroenterology
Provider IdentifiersNPI Number: 1952595159
PECOS PAC ID: 7618030347
Enrollment ID: I20090107000241
Provider NameSamantha Reed
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1558514570
PECOS PAC ID: 7517014715
Enrollment ID: I20090403000397
Provider NameLela Cole
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1609104546
PECOS PAC ID: 1850433848
Enrollment ID: I20100129000183
Provider NameJoel D Talley
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1700999703
PECOS PAC ID: 9234219924
Enrollment ID: I20100322000693
Provider NameRudolph J Triana
Provider TypePractitioner - Otolaryngology
Provider IdentifiersNPI Number: 1811959661
PECOS PAC ID: 4880625573
Enrollment ID: I20100719000878
Provider NameWayne E Williams
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1366544827
PECOS PAC ID: 8527192376
Enrollment ID: I20100816000117
Provider NameSue E Petty
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1477622181
PECOS PAC ID: 2860516200
Enrollment ID: I20100908000018
Provider NameDaniel Howard
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1336136514
PECOS PAC ID: 6002808060
Enrollment ID: I20100917000360
Provider NameMichelle Ann Jewell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1902189491
PECOS PAC ID: 1850563701
Enrollment ID: I20111019000119
Provider NameThomas J Salvucci
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1093783532
PECOS PAC ID: 1456342252
Enrollment ID: I20120813000268
Provider NameSamantha Hudson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1982950432
PECOS PAC ID: 2264689884
Enrollment ID: I20120904000140
Provider NamePuneet Bhatia
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1881927770
PECOS PAC ID: 0648429100
Enrollment ID: I20120927000626
Provider NameBrandi L Stacy
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1760722144
PECOS PAC ID: 8022253921
Enrollment ID: I20130325000529
Provider NameSandy K Riley
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1558603589
PECOS PAC ID: 6305084468
Enrollment ID: I20130530000740
Provider NameSarah E Wilson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144645441
PECOS PAC ID: 0941426928
Enrollment ID: I20140728002220
Provider NameJessica Little
Provider TypePractitioner - Podiatry
Provider IdentifiersNPI Number: 1093093254
PECOS PAC ID: 3476773433
Enrollment ID: I20140925002390
Provider NameElizabeth Dunn
Provider TypePractitioner - Physician Assistant
Provider IdentifiersNPI Number: 1619382918
PECOS PAC ID: 3173843463
Enrollment ID: I20150528001360
Provider NameSarah M Darnell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1023357928
PECOS PAC ID: 0143466425
Enrollment ID: I20150911002312
Provider NameMary Elizabeth Graham
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1417327008
PECOS PAC ID: 5597074781
Enrollment ID: I20151029001767
Provider NameMelisha Danielle Baldwin
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1225204803
PECOS PAC ID: 9739231176
Enrollment ID: I20160614000739
Provider NameBethanie Megen Apperson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710332523
PECOS PAC ID: 3779875067
Enrollment ID: I20160706002649
Provider NameJanine Kathryn Kruger
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1770530289
PECOS PAC ID: 1759275498
Enrollment ID: I20161004002737
Provider NameAllison L Mcclanahan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1649726670
PECOS PAC ID: 9739477563
Enrollment ID: I20161011003147
Provider NameHeather Ballard
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1538615570
PECOS PAC ID: 8224317532
Enrollment ID: I20161109000905
Provider NameJohn G Vansavage
Provider TypePractitioner - Urology
Provider IdentifiersNPI Number: 1467457945
PECOS PAC ID: 6103724737
Enrollment ID: I20170621001974
Provider NameDavid Koury
Provider TypePractitioner - Neurology
Provider IdentifiersNPI Number: 1053526293
PECOS PAC ID: 4789647272
Enrollment ID: I20170906003719
Provider NameStephannie Goodrum
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1700396405
PECOS PAC ID: 7719243781
Enrollment ID: I20171107002069
Provider NameAmy M Turner
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1639680846
PECOS PAC ID: 7416214390
Enrollment ID: I20171130002950
Provider NameJennifer Bartley
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1659852556
PECOS PAC ID: 7113278763
Enrollment ID: I20180921000364
Provider NameDavid E. Collins
Provider TypePractitioner - Thoracic Surgery
Provider IdentifiersNPI Number: 1538120035
PECOS PAC ID: 1951558154
Enrollment ID: I20181204003442
Provider NameBrian Thomas Farrell
Provider TypePractitioner - Neurosurgery
Provider IdentifiersNPI Number: 1073766150
PECOS PAC ID: 4688827744
Enrollment ID: I20190315001396
Provider NameToni Shantel Gordon-bailey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1568091270
PECOS PAC ID: 1557784329
Enrollment ID: I20200713001271
Provider NameNicole Schmidt
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1831796416
PECOS PAC ID: 4486065794
Enrollment ID: I20201117002915
Provider NameLawrence Shin
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1467456137
PECOS PAC ID: 7315946068
Enrollment ID: I20201231001392
Provider NameSimone a Fearon
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1255522801
PECOS PAC ID: 2668535014
Enrollment ID: I20210629001512
Provider NameChristy Byassee
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1477120129
PECOS PAC ID: 3476955162
Enrollment ID: I20210719001196
Provider NameMarty Odom
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1265520662
PECOS PAC ID: 7719943737
Enrollment ID: I20220720001511
Provider NameCaitlin Odom
Provider TypePractitioner - Physician Assistant
Provider IdentifiersNPI Number: 1154767960
PECOS PAC ID: 2668613373
Enrollment ID: I20220725001739
Provider NameLindsay D Fulcher
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1427765486
PECOS PAC ID: 6608245220
Enrollment ID: I20221202002561
Provider NamePhillip H Behrens
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1710470091
PECOS PAC ID: 3678829975
Enrollment ID: I20230124000699
Provider NameKristin Whipple
Provider TypePractitioner - Certified Nurse Midwife (cnm)
Provider IdentifiersNPI Number: 1679046239
PECOS PAC ID: 5991178543
Enrollment ID: I20230301000383
Provider NameDiana L Metzger
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1477563468
PECOS PAC ID: 2668465857
Enrollment ID: I20230705000558
Provider NameMichael Clay Brown
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1386817468
PECOS PAC ID: 6002065083
Enrollment ID: I20230818002626
Provider NameShan C Gordon
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1427455831
PECOS PAC ID: 9830553403
Enrollment ID: I20230914003192
Provider NameLouis Caruso
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1811918287
PECOS PAC ID: 8820083017
Enrollment ID: I20231220002612
Provider NameBrandi Rose
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1437540200
PECOS PAC ID: 0840519443
Enrollment ID: I20240320000125
Provider NameTia a Clark
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1912769290
PECOS PAC ID: 8820436488
Enrollment ID: I20240402003825
Provider NameAndrew Lundberg
Provider TypePractitioner - Vascular Surgery
Provider IdentifiersNPI Number: 1770509705
PECOS PAC ID: 2860485752
Enrollment ID: I20240809000452
Provider NameLinley Wright
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1912758475
PECOS PAC ID: 9335687128
Enrollment ID: I20240812001421
Provider NameChrista D Bewley
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1952139727
PECOS PAC ID: 1951833094
Enrollment ID: I20241015001205
Provider NameAustin Walker Harrison
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356187553
PECOS PAC ID: 3678007945
Enrollment ID: I20241108001262
Provider NameKimberly Crawford
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1417926783
PECOS PAC ID: 1951377530
Enrollment ID: I20250814002083
Provider NameDavid Gossat
Provider TypePractitioner - Gastroenterology
Provider IdentifiersNPI Number: 1295718153
PECOS PAC ID: 0345216941
Enrollment ID: I20251022001219

Reviews and Comments

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.