Pinelake Physician Practice LLC
NPI 1205494085 · Rural Health Clinic/Center · Hickman, KY
Enrolled with Medicare as Part a Provider - Rural Health Clinic · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Pinelake Physician Practice LLC is a Rural Health Clinic/Center organization in Hickman, KY (NPI 1205494085).
Provider details
- NPI number
- 1205494085
- Entity type
- Organization
- Primary specialty
- Rural Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Terrance Dillon, Assistant Secretary(502) 596-7220
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Jackson Purchase Primary Care Hickman Clinic
- Doing business as
- Jackson Purchase Primary Care Hickman Clinic
Registry dates
- Enumerated
- 2019-06-05
- Last updated
- 2022-08-24
- Certified
- 2022-08-24
Frequently asked questions
- What is Pinelake Physician Practice LLC's NPI number?
- Pinelake Physician Practice LLC's National Provider Identifier (NPI) is 1205494085, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Pinelake Physician Practice LLC?
- Pinelake Physician Practice LLC is classified in the NPPES registry as Rural Health Clinic/Center (Ambulatory Health Care Facilities).
- Where is Pinelake Physician Practice LLC located?
- Pinelake Physician Practice LLC's practice location on file with NPPES is 2003 S 7th St, Hickman, KY 42050-1841.
- What is Pinelake Physician Practice LLC's phone number?
- The practice phone number listed in the NPPES registry for Pinelake Physician Practice LLC is (270) 236-3337.
- Does Pinelake Physician Practice LLC accept Medicare?
- Pinelake Physician Practice LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Pinelake Physician Practice LLC?
- The authorized official listed on Pinelake Physician Practice LLC's NPPES record is Terrance Dillon, Assistant Secretary. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Pinelake Physician Practice LLC's NPI active?
- Yes — Pinelake Physician Practice LLC's NPI (1205494085) is active in the NPPES registry as of the last update on 2022-08-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.