NPIMap

Organization Active NPI

Premier Family Care Blountsville, LLC

  • Rural Health Clinic/Center
  • Blountsville, AL
National Provider Identifier
1114540408
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PREMIER FAMILY CARE BLOUNTSVILLE, LLC
Practice address
68278 Main St
Blountsville, AL 35031-3370
Phone
(256) 586-2324
Fax
(256) 586-0024
NPI assigned
May 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Beverly Harper
Title
Office Manager
Phone
(256) 586-2324

Specialties & licenses 1

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

Addresses

Primary practice location

68278 Main St
Blountsville, AL 35031-3370

Mailing address

68278 Main St
Blountsville, AL 35031-3370
Phone (256) 586-2324

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201110000213 AL Part A Provider - Rural Health Clinic 8224458310 Practice locations: Blountsville, AL

Rural health clinic certification: CCN 018949

Legal name
PREMIER FAMILY CARE BLOUNTSVILLE LLC
Doing business as
PREMIER FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 30, 2020
Last certification
Jan 31, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 10, 2020 in AL
Enrollment address
68278 Main St
Blountsville, AL 35031-3370

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Lisa Heard Individual W-2 Managing EmployeeOffice Manager Apr 20, 2021 100%
Jess H Youngblood Individual 5% Or Greater Direct Ownership Interest Nov 16, 2020 100%
W-2 Managing EmployeeMedical Doctor Nov 16, 2020

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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": "1590019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1114540408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68278 MAIN ST",
            "city": "BLOUNTSVILLE",
            "state": "AL",
            "postal_code": "350313370",
            "telephone_number": "256-586-2324",
            "fax_number": "256-586-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68278 MAIN ST",
            "city": "BLOUNTSVILLE",
            "state": "AL",
            "postal_code": "350313370",
            "telephone_number": "256-586-2324",
            "fax_number": "256-586-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY CARE BLOUNTSVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-21",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-586-2324"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountsville, AL

Sources for this page

Verify at the official NPI Registry.