NPIMap

Organization Active NPI

Family Health Care Clinic PSC

  • Rural Health Clinic/Center
  • Richmond, KY
National Provider Identifier
1073717286
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900186 Issued in KY
Legal business name
FAMILY HEALTH CARE CLINIC PSC
Practice address
312 Jason Dr
Suite 9
Richmond, KY 40475-2785
Phone
(859) 626-9696
NPI assigned
Jun 12, 2007
Last updated
Jul 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Authorized official

Name
Kay Stephens, APRNNPI 1013902584
Title
Owner
Phone
(859) 626-9696

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900186 KY Primary
Family Nurse Practitioner 363LF0000X 3002572 KY

Addresses

Primary practice location

312 Jason Dr
Suite 9
Richmond, KY 40475-2785

Mailing address

PO Box 35
Richmond, KY 40476-0035
Phone (859) 626-9696

Other identifiers 1

IdentifierTypeStateIssuer
35001890MedicaidKY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040513000364 KY Part B Supplier - Clinic/Group Practice 7214927268 Receives reassigned benefits from 16 practitioners
Practice locations: Richmond, KY
O20150820012587 KY Part A Provider - Rural Health Clinic 7214927268 Practice locations: Richmond, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073717286. Details of each certification follow.

Rural health clinic certification: CCN 183936

Legal name
FAMILY HEALTH CARE CLINIC PSC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 16, 2005
Last certification
Nov 1, 2019
Ownership / control type
1B
Most recent change of ownership
Mar 1, 2015 (1 total)
Organization structure
CorporationProprietary
Incorporated
Mar 22, 2004 in KY
Enrollment address
1012 Center Dr
Richmond, KY 40475-3838

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
18D1023533Family Health Care Clinic, PSC1012 Center Drive, Richmond, KY 40475Certificate of waiverApr 23, 2028
18D2282846Family Health Care Clinic, PSC1012 Center Drive, Richmond, KY 40475AccreditationJul 29, 2028

National Provider Directory

National Provider Directory

Locations

1012 Center Dr
Richmond, KY 40475
Phone (859) 626-9694

312 Jason Dr
Ste 9
Richmond, KY 40475
Phone (859) 575-4075

946 Commercial Dr
Richmond, KY 40475
Phone (859) 626-9696

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Kim Aprn Cox Individual 5% Or Greater Direct Ownership Interest Mar 1, 2015 100%
Corporate OfficerCeo Mar 1, 2015 100%
W-2 Managing EmployeeCeo Mar 1, 2015 100%

Owners & managing parties with NPI records 1

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

  • Kim B Cox, APRN
    • Psychiatric/Mental Health Nurse Practitioner
    • Booneville, KY
    • NPI 1326131434

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1073717286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404760035",
            "telephone_number": "859-626-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 JASON DR",
            "address_2": "SUITE 9",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752785",
            "telephone_number": "859-626-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-626-9696",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900186",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3002572",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001890",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, KY

Sources for this page

Verify at the official NPI Registry.