NPIMap

Organization Active NPI

Hilltop Primary Care, Inc

  • Rural Health Clinic/Center
  • Phelps, KY
National Provider Identifier
1124084488
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900167 Issued in KY
Legal business name
HILLTOP PRIMARY CARE, INC
Practice address
7617 Upper Johns Creek Rd
Phelps, KY 41553-8775
Phone
(606) 835-9333
Fax
(606) 835-9997
NPI assigned
Apr 25, 2006
Last updated
Dec 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Zach Harris
Title
Ceo
Phone
(606) 835-9333

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X 900167 KY Primary
Clinical Medical Laboratory 291U00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

7617 Upper Johns Creek Rd
Phelps, KY 41553-8775

Mailing address

7617 Upper Johns Creek Rd
Phelps, KY 41553-8775
Phone (606) 835-9333

Other identifiers 3

IdentifierTypeStateIssuer
45001880MedicaidKY
78903309MedicaidKY
35001973MedicaidKY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040324001203 KY Part A Provider - Rural Health Clinic 8628969847 Practice locations: Phelps, KY
O20051103000179 KY Part B Supplier - Clinic/Group Practice 8628969847 Receives reassigned benefits from 13 practitioners
Practice locations: Phelps, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124084488. Details of each certification follow.

Rural health clinic certification: CCN 183943

Legal name
HILLTOP PRIMARY CARE INC
Doing business as
NA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 29, 2005
Last certification
Jul 10, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
May 29, 2003 in KY
Enrollment address
7617 Upper Johns Creek Rd
Phelps, KY 41553-8775

National Provider Directory

National Provider Directory
Tax ID family
Hilltop Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Endure Health Holdings, LLC Organization, Nashville, TN Management services company Operational/Managerial Control Jun 30, 2023
Zachary Harris Individual 5% Or Greater Direct Ownership Interest Nov 18, 2024 100%
Corporate OfficerCeo Jun 30, 2023 100%
James Robert Hager Individual W-2 Managing Employee Jun 30, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1124084488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7617 UPPER JOHNS CREEK RD",
            "city": "PHELPS",
            "state": "KY",
            "postal_code": "415538775",
            "telephone_number": "606-835-9333",
            "fax_number": "606-835-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7617 UPPER JOHNS CREEK RD",
            "city": "PHELPS",
            "state": "KY",
            "postal_code": "415538775",
            "telephone_number": "606-835-9333",
            "fax_number": "606-835-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLTOP PRIMARY CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-835-9333"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900167",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45001880",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78903309",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001973",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phelps, KY

Sources for this page

Verify at the official NPI Registry.