Active NPI
Monticello Medical Associates, Inc
- Federally Qualified Health Center (FQHC)
- Monticello, KY
National Provider Identifier
1063007672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- MONTICELLO MEDICAL ASSOCIATES, INC
- Practice address
- 1 S Creek Dr Ste 102
Monticello, KY 42633-9472 - Phone
- (606) 348-3365
- NPI assigned
- Mar 5, 2021
- Organization subpart
- Yes
- Parent organization
- MONTICELLO MEDICAL ASSOCIATES, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Parmelee
- Title
- Ceo
- Phone
- (606) 348-3365
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary |
Addresses
Primary practice location
1 S Creek Dr Ste 102
Monticello, KY 42633-9472
Mailing address
1 S Creek Dr Ste 102
Monticello, KY 42633-9472
Phone (606) 348-3365
Other names 1
- Monticello Medical Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040429000965 | KY | Part B Supplier - Clinic/Group Practice | 2062409154 |
Receives reassigned benefits from 12 practitioners 1 other NPI on this enrollment Practice locations: Monticello, KY |
| O20210503002142 | KY | Part A Provider - Federally Qualified Health Center (FQHC) | 2062409154 | Practice locations: Monticello, KY |
Federally qualified health center certification: CCN B01010
- Legal name
- MONTICELLO MEDICAL ASSOCIATES, INC.
- Doing business as
- MONTICELLO MEDICAL ASSOCIATES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 3, 2021
- Last certification
- May 3, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Other
- Incorporated
- Jun 1, 2020 in KY
- Enrollment address
- 1 S Creek Dr
Ste 102
Monticello, KY 42633-9472
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Monticello, KY
- NPI 1104963305
O20040429000965
National Provider Directory
National Provider Directory- Part of
- Phillips-Prattmcfarlan
Locations
1 S Creek Dr
Ste 102
Monticello, KY 42633
Phone (606) 348-3365
858 Eastern Byp
Richmond, KY 40475
Phone (859) 626-0072
Ownership & related parties
All disclosed owners & managing parties 9
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Diane Sutton | Corporate Director | Mar 1, 2021 | |
| Brenda Pryor | Corporate Director | Mar 1, 2021 | |
| Robert Parmelee | Corporate Officer | Mar 1, 2021 | |
| W-2 Managing Employee | Mar 1, 2021 | ||
| Joyce Owens | Corporate Director | Mar 1, 2021 | |
| Cynthia Woods | Corporate Director | Mar 1, 2021 | |
| Joyce Bell | Corporate Director | Mar 1, 2021 | |
| Barbara Turpin | Corporate Director | Mar 1, 2021 | |
| Sherry Barnes | Corporate Director | Mar 1, 2021 | |
| Robert L Allen | Corporate Director | Mar 1, 2021 |
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614902400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729728000000",
"number": "1063007672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 S CREEK DR STE 102",
"city": "MONTICELLO",
"state": "KY",
"postal_code": "426339472",
"telephone_number": "606-348-3365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 S CREEK DR STE 102",
"city": "MONTICELLO",
"state": "KY",
"postal_code": "426339472",
"telephone_number": "606-348-3365"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MONTICELLO MEDICAL ASSOCIATES, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MONTICELLO MEDICAL ASSOCIATES, INC",
"enumeration_date": "2021-03-05",
"last_updated": "2024-10-24",
"certification_date": "2024-10-24",
"status": "A",
"authorized_official_last_name": "PARMELEE",
"authorized_official_first_name": "ROBERT",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "606-348-3365"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Monticello Medical Associates",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Monticello Medical Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Monticello, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.