NPIMap

Organization Active NPI

Faith Healthcare Inc

Doing business as Community Care Clinic

  • Federally Qualified Health Center (FQHC)
  • Monticello, KY
National Provider Identifier
1053964965
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAITH HEALTHCARE INC
Doing business as
Community Care Clinic
Practice address
126 Franklin Drive
Monticello, KY 42633
Phone
(606) 685-6131
Fax
(606) 685-6179
NPI assigned
Jul 19, 2019
Last updated
Aug 6, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FAITH HEALTHCARE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Authorized official

Name
Cory Ryan, MDNPI 1467443879
Title
Ceo
Phone
(606) 425-5768

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

126 Franklin Drive
Monticello, KY 42633

Mailing address

PO Box 969
Somerset, KY 42502-0969
Phone (066) 425-5768

Other names 1

  • Community Care Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tabathaflynn@faithhealthcareky.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190909002402 KY Part B Supplier - Clinic/Group Practice 0840529335 Receives reassigned benefits from 39 practitioners
2 other NPIs on this enrollment
Practice locations: Monticello, KY; Nancy, KY; Science Hill, KY
O20210407000974 KY Part A Provider - Federally Qualified Health Center (FQHC) 0840529335 Practice locations: Monticello, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053964965. Details of each certification follow.

Federally qualified health center certification: CCN B01009

Legal name
FAITH HEALTHCARE INC
Doing business as
COMMUNITY CARE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 7, 2021
Last certification
Apr 7, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 23, 2014 in KY
Enrollment address
126 Franklin Rd
Monticello, KY 42633-2245

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2173473Community Care Clinic126 Franklin Drive, Monticello, KY 42633Provider-performed microscopyOct 14, 2027

National Provider Directory

National Provider Directory
Part of
Faith Healthcare Inc

Locations

325 Richmond St
Mount Vernon, KY 40456
Phone (606) 256-5812

5775 N Highway 27
Science Hill, KY 42553
Phone (606) 423-9959

5775 N Highway 27
Ste 7
Science Hill, KY 42553
Phone (606) 219-4905

26 Oxford Way
Ste A
Somerset, KY 42503
Phone (606) 679-5161

54 Imaging Dr
Somerset, KY 42503
Phone (606) 451-2273

Interoperability endpoints

  • Direct secure messaging: tabathaflynn@faithhealthcareky.net

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
John Sloan Individual Corporate OfficerChief Compliance Officer Jan 1, 2023
Cody Dishman Individual Corporate DirectorBoard Member Jan 1, 2023
Adam Ellis Individual Corporate DirectorBoard Member Jan 1, 2023
Jennifer Tindall Individual Corporate DirectorBoard Member Jan 1, 2023
Julie Parent Individual Corporate DirectorBoard Member Jan 1, 2023
Chelsey Staton Individual Corporate DirectorBoard Member Jan 1, 2023
Jonathan Grider Individual Corporate DirectorBoard Member Mar 1, 2021
Whitney Davis Individual Corporate OfficerCfo Jan 1, 2023
Shannon Thompson Individual Corporate DirectorBoard Member Jan 1, 2023
Brently Robertson Individual Corporate DirectorBoard Member Mar 1, 2021
Heather Slavey Individual Corporate OfficerChief Human Resource Officer Jan 1, 2023
Kristen Upchurch Individual Corporate DirectorBoard Member Mar 1, 2021
Kelli Chaney Individual Corporate OfficerChief Administrative Officer Jan 1, 2023
Cory Ryan Individual Corporate OfficerCeo May 31, 2024
W-2 Managing EmployeeCeo May 31, 2024
Tabatha Flynn Individual Operational/Managerial ControlSenior Project Director Jan 1, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1053964965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425020969",
            "telephone_number": "066-425-5768",
            "fax_number": "606-425-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 FRANKLIN DRIVE",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "42633",
            "telephone_number": "606-685-6131",
            "fax_number": "606-685-6179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH HEALTHCARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAITH HEALTHCARE INC.",
        "enumeration_date": "2019-07-19",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-425-5768",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tabathaflynn@faithhealthcareky.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "521 Crane Rd",
            "city": "Somerset",
            "state": "KY",
            "country_code": "US",
            "postal_code": "425019503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Community Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, KY

Sources for this page

Verify at the official NPI Registry.