NPIMap

Organization Active NPI

Ack Healthcare Management, LLC

Doing business as Saint Camillus Urgent Care

  • Nurse Practitioner
  • Lewisport, KY
National Provider Identifier
1154748986
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ACK HEALTHCARE MANAGEMENT, LLC
Doing business as
Saint Camillus Urgent Care
Practice address
1520 4TH St
Lewisport, KY 42351
Phone
(270) 295-3890
Fax
(270) 295-3891
NPI assigned
Mar 18, 2014
Last updated
Aug 29, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Authorized official

Name
Charles Young
Title
Owner/Member
Phone
(812) 489-0862

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1520 4TH St
Lewisport, KY 42351

Mailing address

PO Box 1099
Owensboro, KY 42302-1099
Phone (502) 277-5170

Other identifiers 2

IdentifierTypeStateIssuer
7100295770MedicaidKY
18D2054463OtherKYCLIA

Other names 1

  • Saint Camillus Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140528001695 KY Part B Supplier - Clinic/Group Practice 3072736602 Receives reassigned benefits from 28 practitioners
4 other NPIs on this enrollment
Practice locations: Hardinsburg, KY; Leitchfield, KY; Lewisport, KY

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Ack Healthcare Management LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

312 N Main St
Leitchfield, KY 42754
Phone (270) 287-0087

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": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1154748986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1099",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423021099",
            "telephone_number": "502-277-5170",
            "fax_number": "502-277-5172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 4TH ST",
            "city": "LEWISPORT",
            "state": "KY",
            "postal_code": "42351",
            "telephone_number": "270-295-3890",
            "fax_number": "270-295-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACK HEALTHCARE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-18",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "812-489-0862"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100295770",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "18D2054463",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Camillus Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Saint Camillus Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewisport, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; 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.