NPIMap

Organization Active NPI

Knox County General Health District

Doing business as KCCHC Walk-In Clinic

  • Federally Qualified Health Center (FQHC)
  • Mount Vernon, OH
National Provider Identifier
1033878962
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KNOX COUNTY GENERAL HEALTH DISTRICT
Doing business as
KCCHC Walk-In Clinic
Practice address
207 W High St
Mount Vernon, OH 43050-2427
Phone
(740) 392-1181
Fax
(740) 392-1180
NPI assigned
Dec 8, 2021
Last updated
Dec 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KNOX COUNTY GENERAL HEALTH DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lane Keyes Belangia
Title
Ceo
Phone
(740) 392-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

207 W High St
Mount Vernon, OH 43050-2427

Mailing address

11660 Upper Gilchrist Rd
Mount Vernon, OH 43050-9084
Phone (740) 392-2200

Other identifiers 1

IdentifierTypeStateIssuer
216583MedicaidOH

Other names 1

  • KCCHC Walk-In Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220421000184 OH Part A Provider - Federally Qualified Health Center (FQHC) 8820078595 Practice locations: Mount Vernon, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033878962. Details of each certification follow.

Federally qualified health center certification: CCN 721964

Legal name
KNOX COUNTY GENERAL HEALTH DISTRICT
Doing business as
KCCHC WALK-IN CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 25, 2022
Last certification
Mar 25, 2022
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
207 W High St
Mount Vernon, OH 43050-2427

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Knox County General HLT10 organizations share this tax ID, including this one
Part of
Knox County General HLT

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

206 S Mulberry St
Ste C
Mount Vernon, OH 43050
Phone (740) 399-3008

207 W High St
Ste A
Mount Vernon, OH 43050

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jason Whaley Individual Corporate OfficerPresident Pro Tempore of the Boa Jul 1, 2022
Zachary Green Individual Corporate OfficerSecretary of the Board of Health Jul 1, 2022
W-2 Managing EmployeeHealth Commissioner Jul 1, 2022
Jeff Harmer Individual Corporate OfficerPresident of the Board of Health Jul 1, 2022
Knox County General Health District Organization, Mount Vernon, OH 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
5% Or Greater Security Interest Jan 1, 2022 100%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Knox County Community Health CenterMount Vernon, OH, CCN 361130 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Danville Community Health CenterDanville, OH, CCN 721843 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2019
Knox County DentalDanville, OH, CCN 721883 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 11, 2021
Behavioral Health of Mount Vernon Health CenterMount Vernon, OH, CCN 721977 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)		 Jan 1, 2022
Jan 1, 2022
Mount Vernon Health CenterMount Vernon, OH, CCN D21026 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2024
Jan 1, 2024
Centerburg Health CenterCenterburg, OH, CCN D21104 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2025

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1033878962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11660 UPPER GILCHRIST RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509084",
            "telephone_number": "740-392-2200",
            "fax_number": "740-393-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W HIGH ST",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430502427",
            "telephone_number": "740-392-1181",
            "fax_number": "740-392-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOX COUNTY GENERAL HEALTH DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KNOX COUNTY GENERAL HEALTH DISTRICT",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "BELANGIA",
        "authorized_official_first_name": "LANE",
        "authorized_official_middle_name": "KEYES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "740-392-2200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "216583",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KCCHC Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, OH

Sources for this page

Verify at the official NPI Registry.