NPIMap

Organization Active NPI

Means Adult Primary Care Clinic of Kentucky PLLC

  • Rural Health Clinic/Center
  • Winchester, KY
National Provider Identifier
1124665807
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Practice address
1145 W Lexington Ave FL 2
Winchester, KY 40391-1290
Phone
(859) 744-0301
Fax
(859) 744-0608
NPI assigned
Dec 2, 2019
Last updated
May 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Authorized official

Name
Rezkalla ButrosNPI 1023037082
Title
MD/Owner
Phone
(859) 499-0717

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1145 W Lexington Ave FL 2
Winchester, KY 40391-1290

Mailing address

148 Skyview Dr
Mount Sterling, KY 40353-1496
Phone (859) 499-0717

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000659 KY Part B Supplier - Clinic/Group Practice 5395642177 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mt Sterling, KY; Winchester, KY; Richmond, KY
O20230607001012 KY Part A Provider - Rural Health Clinic 5395642177 Practice locations: Winchester, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124665807. Details of each certification follow.

Rural health clinic certification: CCN B03948

Legal name
MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 7, 2023
Last certification
Dec 7, 2023
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Feb 6, 2003 in KY
Enrollment address
1145 W Lexington Ave
Winchester, KY 40391-1290

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 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1107521Means Adult Primary Care of Kentucky, PLLC1145 W Lexington Ave, 2ND Floor, Ste a, Winchester, KY 40391Certificate of waiverNov 5, 2027

National Provider Directory

National Provider Directory

Locations

1145 W Lexington Ave
Fl 2
Winchester, KY 40391
Phone (859) 744-0301

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
Rezkalla a Butros Individual 5% Or Greater Direct Ownership Interest Feb 6, 2003 100%
Tammy Layne Individual Contracted Managing Employee Feb 6, 2003
Corporate Director Feb 6, 2003

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 3

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": "1575244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1124665807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 SKYVIEW DR",
            "city": "MOUNT STERLING",
            "state": "KY",
            "postal_code": "403531496",
            "telephone_number": "859-499-0717",
            "fax_number": "859-499-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 W LEXINGTON AVE FL 2",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403911290",
            "telephone_number": "859-744-0301",
            "fax_number": "859-744-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-02",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "BUTROS",
        "authorized_official_first_name": "REZKALLA",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "859-499-0717"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, KY

Sources for this page

Verify at the official NPI Registry.