Family Clinic at the Lake PLLC
NPI 1578125647 · Rural Health Clinic/Center · Counce, TN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Family Clinic at the Lake PLLC is a Rural Health Clinic/Center organization in Counce, TN (NPI 1578125647).
Provider details
- NPI number
- 1578125647
- Entity type
- Organization
- Primary specialty
- Rural Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Ellanikole Jackson, Owner(731) 689-4357
Specialties & taxonomies
Ambulatory Health Care Facilities
- Nurse Practitioner363L00000X
Physician Assistants & Advanced Practice Nursing Providers
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
Registry dates
- Enumerated
- 2019-06-28
- Last updated
- 2019-10-14
Frequently asked questions
- What is Family Clinic at the Lake PLLC's NPI number?
- Family Clinic at the Lake PLLC's National Provider Identifier (NPI) is 1578125647, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Family Clinic at the Lake PLLC?
- Family Clinic at the Lake PLLC is classified in the NPPES registry as Rural Health Clinic/Center (Ambulatory Health Care Facilities).
- Where is Family Clinic at the Lake PLLC located?
- Family Clinic at the Lake PLLC's practice location on file with NPPES is 11268 Highway 57, Counce, TN 38326-3802.
- What is Family Clinic at the Lake PLLC's phone number?
- The practice phone number listed in the NPPES registry for Family Clinic at the Lake PLLC is (731) 689-4357.
- Does Family Clinic at the Lake PLLC accept Medicare?
- Family Clinic at the Lake PLLC 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 Family Clinic at the Lake PLLC?
- The authorized official listed on Family Clinic at the Lake PLLC's NPPES record is Ellanikole Jackson, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Family Clinic at the Lake PLLC's NPI active?
- Yes — Family Clinic at the Lake PLLC's NPI (1578125647) is active in the NPPES registry as of the last update on 2019-10-14.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.