NPIMap

Organization Active NPI

Arh Mary Breckinridge Health Services, Inc.

Doing business as Hyden ARH Clinic

  • Rural Health Clinic/Center
  • Hyden, KY
National Provider Identifier
1073898102
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Doing business as
Hyden ARH Clinic
Practice address
130 Kate Ireland Dr
Hyden, KY 41749-9071
Phone
(606) 672-2901
Fax
(859) 226-2657
NPI assigned
Oct 20, 2011
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
APPALACHIAN REGIONAL HELATHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Ms. Hollie Harris
Title
President and Ceo
Phone
(859) 226-2511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

130 Kate Ireland Dr
Hyden, KY 41749-9071

Mailing address

130 Kate Ireland Dr
Hyden, KY 41749-9071
Phone (606) 672-2901

Other identifiers 1

IdentifierTypeStateIssuer
71000218090MedicaidKY

Other names 1

  • Hyden ARH Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111209000227 KY Part A Provider - Rural Health Clinic 8123293818 Practice locations: Hyden, KY
O20121003000026 KY Part B Supplier - Clinic/Group Practice 8123293818 Receives reassigned benefits from 39 practitioners
2 other NPIs on this enrollment
Practice locations: Big Creek, KY; Hyden, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073898102. Details of each certification follow.

Rural health clinic certification: CCN 183472

Legal name
ARH MARY BRECKINRIDGE HEALTH SERVICES INC
Doing business as
HYDEN ARH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 7, 2011
Last certification
Jan 8, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 31, 2011 in KY
Enrollment address
130 Kate Ireland Drive
Hyden, KY 41749-9071
Related CCNs
181316

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 18

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

View all 18

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
18D1011527Hyden Arh Clinic130 Kate Ireland Drive, Hyden, KY 41749Provider-performed microscopyApr 13, 2027

National Provider Directory

National Provider Directory
Part of
Arh Consolidated Lab

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Hollie Harris Individual Corporate OfficerCeo and President May 10, 2021
Corporate DirectorCeo and President May 10, 2021
Appalachian Regional Healthcare Inc Organization, Lexington, KY Non-profit Operational/Managerial Control Sep 7, 2011 100%
Andrea Massey Individual Corporate DirectorBoard Member Nov 8, 2019
Susan Renae Neace Individual W-2 Managing EmployeeSys. Dir of Med. Aff and Enrollment Jan 3, 2005
Mallie Napier-Noble Individual W-2 Managing Employee Sep 7, 2011

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1073898102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 KATE IRELAND DR",
            "city": "HYDEN",
            "state": "KY",
            "postal_code": "417499071",
            "telephone_number": "606-672-2901",
            "fax_number": "859-226-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 KATE IRELAND DR",
            "city": "HYDEN",
            "state": "KY",
            "postal_code": "417499071",
            "telephone_number": "606-672-2901",
            "fax_number": "859-226-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "APPALACHIAN REGIONAL HELATHCARE, INC.",
        "enumeration_date": "2011-10-20",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "HOLLIE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "859-226-2511",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71000218090",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Hyden ARH Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hyden ARH Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hyden, KY

Sources for this page

Verify at the official NPI Registry.