NPIMap

Organization Active NPI

Pennyroyal Healthcare Services, Inc

Doing business as Community Dental

  • Federally Qualified Health Center (FQHC)
  • Hopkinsville, KY
National Provider Identifier
1104532332
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENNYROYAL HEALTHCARE SERVICES, INC
Doing business as
Community Dental
Practice address
1102 S Virginia St Ste B
Hopkinsville, KY 42240-3579
Phone
(270) 632-3088
NPI assigned
Jan 31, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Starla Cummings
Title
Cfo
Phone
(270) 365-0227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1102 S Virginia St Ste B
Hopkinsville, KY 42240-3579

Mailing address

PO Box 151
Princeton, KY 42445-0151
Phone (270) 365-0227

Other names 1

  • Community Dental Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000101 KY Part B Supplier - Clinic/Group Practice 6002076700 Receives reassigned benefits from 30 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hopkinsville, KY; Oak Grove, KY; Princeton, KY

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Community Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

739 North Dr
#B
Hopkinsville, KY 42240
Phone (270) 887-6152

15095 Fort Campbell Blvd
Oak Grove, KY 42262
Phone (270) 887-6152

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1104532332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424450151",
            "telephone_number": "270-365-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 S VIRGINIA ST STE B",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422403579",
            "telephone_number": "270-632-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNYROYAL HEALTHCARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "CUMMINGS",
        "authorized_official_first_name": "STARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "270-365-0227"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hopkinsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.