NPIMap

Organization Active NPI

Arh Mary Breckinridge Health Services, Inc.

  • Rural Health Clinic/Center
  • Martin, KY
National Provider Identifier
1174016281
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Practice address
12579 Main St
Martin, KY 41649-7400
Phone
(606) 285-0681
NPI assigned
Jun 13, 2018
Organization subpart
Yes
Parent organization
APPALACHIAN REGIONAL HELATHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Ms. Hollie Harris
Title
President and Ceo
Phone
(859) 226-2511

Specialties & licenses 1

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

Addresses

Primary practice location

12579 Main St
Martin, KY 41649-7400

Mailing address

100 Airport Gardens Rd
Hazard, KY 41701-9529
Phone (606) 487-7524

Other names 1

  • ARH Primary Care Associates - NJ Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170728001694 KY Part B Supplier - Clinic/Group Practice 8123293818 Receives reassigned benefits from 97 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pikeville, KY; Martin, KY; Crestwood, KY; Louisville, KY; Lexington, KY; Harold, KY; Barbourville, KY; Ashland, KY
O20180815002381 KY Part A Provider - Rural Health Clinic 8123293818 Practice locations: Martin, KY

Rural health clinic certification: CCN 183442

Legal name
ARH MARY BRECKINRIDGE HEALTH SERVICES INC
Doing business as
ARH PRIMARY CARE ASSOCIATES - NJ
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 14, 1999
Last certification
Jan 16, 2019
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2008 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 31, 2011 in KY
Enrollment address
12579 Main St
Ste 101
Martin, KY 41649-7400
Related CCNs
181305

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 8

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
18D0949687Arh Primary Care Associates12579 Main Street, Suite 101, Martin, KY 41649Certificate of waiverJan 19, 2027

National Provider Directory

National Provider Directory
Part of
Arh Hazard Family Healt

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Hollie Harris Individual Corporate OfficerPresident and Ceo May 10, 2021
Corporate DirectorPresident and Ceo May 10, 2021
Appalachian Regional Healthcare Inc Organization, Lexington, KY Non-profit Operational/Managerial Control May 31, 2011 100%
Andrea Massey Individual Corporate DirectorChief Legal Officer Nov 8, 2019
Christi Lee Individual Corporate OfficerChief Legal Officer Nov 28, 2023
Corporate DirectorChief Legal Officer Nov 28, 2023
Byron Lynn Gabbard Individual Corporate OfficerChief Financial Officer Nov 28, 2023
Corporate DirectorChief Financial Officer Nov 28, 2023
Susan Renae Neace Individual W-2 Managing EmployeeSys Director of Medical Affairs Jan 3, 2005
Roy Milwee Individual W-2 Managing EmployeeSys Admin of Ambulatory Services May 9, 2016

Facilities with the same owner 22

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 22

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2018 Change of OwnershipThis provider was the buyer Martin ClinicCCN 183442, KY, NPI 1487689519

Practitioners & affiliated clinicians

Practitioners 95

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1174016281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 AIRPORT GARDENS RD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417019529",
            "telephone_number": "606-487-7524",
            "fax_number": "606-439-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12579 MAIN ST",
            "city": "MARTIN",
            "state": "KY",
            "postal_code": "416497400",
            "telephone_number": "606-285-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "APPALACHIAN REGIONAL HELATHCARE, INC.",
        "enumeration_date": "2018-06-13",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "HOLLIE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "859-226-2511",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ARH Primary Care Associates - NJ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ARH Primary Care Associates - NJ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martin, KY

Sources for this page

Verify at the official NPI Registry.