NPIMap

Organization Active NPI

Jackson Hospital Corporation

Doing business as Beattyville Family Medical Clinic

  • Rural Health Clinic/Center
  • Beattyville, KY
National Provider Identifier
1083950414
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
100620 Issued in KY
Legal business name
JACKSON HOSPITAL CORPORATION
Doing business as
Beattyville Family Medical Clinic
Practice address
1027 Highway 11 N
Beattyville, KY 41311-9240
Phone
(606) 464-0061
Fax
(606) 464-0420
NPI assigned
Dec 12, 2012
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Laura J Fey
Title
Sr. Director Physician Rev Cycle
Phone
(615) 221-3641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 100620 KY Primary

Addresses

Primary practice location

1027 Highway 11 N
Beattyville, KY 41311-9240

Mailing address

1573 Mallory LN Ste 100
Brentwood, TN 37027-2895
Phone (152) 221-1400

Other names 1

  • Beattyville Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130311000462 KY Part A Provider - Rural Health Clinic 0345134318 Practice locations: Beattyville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083950414. Details of each certification follow.

Rural health clinic certification: CCN 183480

Legal name
JACKSON HOSPITAL CORPORATION
Doing business as
BEATTYVILLE FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 22, 2013
Last certification
Mar 4, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
1027 Highway 11 N
Beattyville, KY 41311-9240
Related CCNs
181334

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Jackson Hospital Corpor4 organizations share this tax ID, including this one
Part of
Jackson Hospital Corpor

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jackson Hospital Corporation Organization, Brentwood, TN 5% Or Greater Direct Ownership Interest Apr 29, 2016
Henry Kunath Individual Corporate OfficerSr Vice President/Treasurer/Cfo Sep 6, 2023
Corporate DirectorSr Vice President/Treasurer/Cfo Sep 6, 2023
Derek Cimala Individual W-2 Managing EmployeeCeo May 20, 2019
Quorum Health Corporation Organization, Brentwood, TN Corporation 5% Or Greater Direct Ownership Interest Apr 29, 2016 100%
Gtam Onshore Blocker 2 LLC Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Dec 20, 2023 19.34%
Goldentree Distressed Onshore Master Fund III LP Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Aug 5, 2020 6.8%
Laura Fey Individual Corporate DirectorVP of Revenue Cycle Aug 27, 2018
Goldentree Select Offshore Intermediate Fund LP Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Jul 7, 2020 5.44%
Goldentree Distressed Master Fund III LTD Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Jul 7, 2020 11%
Quincy Health LLC Organization, New York, NY Created for acquisition, LLC 5% Or Greater Indirect Ownership Interest Jul 7, 2020 100%
Steven W Frantz Individual Corporate OfficerVice President Aug 10, 2022
Corporate DirectorVice President Aug 10, 2022
Julie Manas Individual Corporate OfficerPresident Aug 10, 2022
Corporate DirectorPresident Aug 10, 2022
Donald Esposito Individual Corporate OfficerSVP & Secretary Sep 16, 2021
Corporate DirectorSVP & Secretary Sep 16, 2021

Owners & managing parties with NPI records 4

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

Facilities with the same owner 32

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

  • Hospital of Louisa, Inc.

    dba Three Rivers Medical Center

    • General Acute Care Hospital
    • Louisa, KY
    • NPI 1063484483

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Hospital of Louisa, Inc.

    dba Three Rivers Medical Center

    • Psychiatric Hospital Unit
    • Louisa, KY
    • NPI 1356313407

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Hospital of Louisa, Inc.

    dba Three Rivers Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Louisa, KY
    • NPI 1952373276

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Jackson Hospital Corporation

    dba Kentucky River Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Jackson, KY
    • NPI 1295985596

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Jackson Hospital Corporation

    dba Kentucky River Medical Center

    • Critical Access Hospital
    • Jackson, KY
    • NPI 1346247962

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Jackson Hospital Corporation

    dba Kentucky River Clinics

    • Rural Health Clinic/Center
    • Jackson, KY
    • NPI 1912518978

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Three Rivers Medical Clinics Inc
    • Rural Health Clinic/Center
    • Louisa, KY
    • NPI 1285301952

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Three Rivers Medical Clinics Inc
    • Rural Health Clinic/Center
    • Louisa, KY
    • NPI 1376210047

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Three Rivers Medical Clinics Inc

    dba Three Rivers Family Practice - Riverview

    • Rural Health Clinic/Center
    • Louisa, KY
    • NPI 1437824406

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Three Rivers Medical Clinics Inc

    dba Three Rivers Family Practice - Inez

    • Rural Health Clinic/Center
    • Inez, KY
    • NPI 1699038737

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Big Bend Hospital Corporation
    • Rural Health Clinic/Center
    • Alpine, TX
    • NPI 1275988669

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
  • Big Bend Hospital Corporation

    dba Big Bend Regional Medical Center

    • Critical Access Hospital
    • Alpine, TX
    • NPI 1356312243

    Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation

    CMS ownership
View all 32

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": "1355270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1083950414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1573 MALLORY LN STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272895",
            "telephone_number": "152-221-1400",
            "fax_number": "615-469-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 HIGHWAY 11 N",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413119240",
            "telephone_number": "606-464-0061",
            "fax_number": "606-464-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON HOSPITAL CORPORATION",
        "enumeration_date": "2012-12-12",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "FEY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. DIRECTOR PHYSICIAN REV CYCLE",
        "authorized_official_telephone_number": "615-221-3641"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "100620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beattyville Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beattyville Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beattyville, KY

Sources for this page

Verify at the official NPI Registry.