NPIMap

Organization Active NPI

Pennyroyal Healthcare Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hopkinsville, KY
National Provider Identifier
1124319942
Registry record updated Mar 16, 2018
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.
Practice address
1102 S Virginia St
Hopkinsville, KY 42240-3579
Phone
(270) 365-0227
Fax
(270) 365-2559
NPI assigned
Apr 27, 2011
Last updated
Mar 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Authorized official

Name
Mrs. Kecia FulcherNPI 1386726388
Title
Ceo/Director
Phone
(270) 886-2205

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1102 S Virginia St
Hopkinsville, KY 42240-3579

Mailing address

310 Hawthorne St
Princeton, KY 42445-1622
Phone (270) 365-0227

Other identifiers 1

IdentifierTypeStateIssuer
7100200060MedicaidKY

Medicare participation

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

Enrollment records 2

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
Practice locations: Hopkinsville, KY; Oak Grove, KY; Princeton, KY
O20150505000156 KY Part A Provider - Federally Qualified Health Center (FQHC) 6002076700 Practice locations: Hopkinsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124319942. Details of each certification follow.

Federally qualified health center certification: CCN 181931

Legal name
PENNYROYAL HEALTHCARE SERVICES, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2015
Last certification
Apr 16, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 6, 2010 in KY
Enrollment address
1102 S Virginia St
Hopkinsville, KY 42240-3579

Other NPIs with the same Medicare PAC ID 2

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

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

Locations

1102 S Virginia St
Ste A
Hopkinsville, KY 42240

739B North Dr
Hopkinsville, KY 42240

310 Hawthorne St
Princeton, KY 42445
Phone (270) 365-0227

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rhonda Kay Oldham Individual Corporate DirectorBoard Member Jan 10, 2018
Amy Berry Individual Corporate DirectorBoard Member Feb 22, 2019
Jill Giordano Individual Corporate DirectorBoard Member Apr 11, 2019
Chet Freeman Individual Corporate DirectorBoard Member Sep 4, 2019
Michelle Wyatt Individual Corporate DirectorBoard Member Dec 28, 2021
Kelly Martin Individual Corporate DirectorBoard Member Mar 22, 2018
Kecia E Fulcher Individual Corporate OfficerCeo Jun 1, 2014
W-2 Managing EmployeeCeo Jun 1, 2014
Kelly Falder Individual Corporate DirectorBoard Member May 24, 2016
Starla D Cummings Individual Corporate OfficerCfo Apr 20, 2020
W-2 Managing EmployeeCfo May 5, 2015
Operational/Managerial ControlCfo Apr 20, 2020
Jennifer Beckett Individual Corporate DirectorBoard Member Sep 21, 2018
Pat Godwin Individual Corporate DirectorBoard Member Dec 28, 2021
George Patterson Individual Corporate DirectorBoard Member Oct 23, 2016

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 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1124319942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 HAWTHORNE ST",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424451622",
            "telephone_number": "270-365-0227",
            "fax_number": "270-365-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 S VIRGINIA ST",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422403579",
            "telephone_number": "270-365-0227",
            "fax_number": "270-365-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNYROYAL HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-27",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "FULCHER",
        "authorized_official_first_name": "KECIA",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "270-886-2205",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100200060",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hopkinsville, KY

Sources for this page

Verify at the official NPI Registry.