NPIMap

Organization Active NPI

Mountain Comprehensive Care Center, Inc.

Doing business as Homeplace Clinic Paintsville

  • Federally Qualified Health Center (FQHC)
  • Paintsville, KY
National Provider Identifier
1184182180
Registry record updated Mar 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN COMPREHENSIVE CARE CENTER, INC.
Doing business as
Homeplace Clinic Paintsville
Practice address
1110 S Mayo TRL
Paintsville, KY 41240-1273
Phone
(606) 789-3518
Fax
(606) 789-3530
NPI assigned
Mar 8, 2019
Last updated
Mar 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAIN COMPREHENSIVE CARE CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2019

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

Authorized official

Name
Roxann Cordial
Title
Credentialing
Phone
(606) 886-8572

Specialties & licenses 1

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

Addresses

Primary practice location

1110 S Mayo TRL
Paintsville, KY 41240-1273

Mailing address

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572

Other names 1

  • Homeplace Clinic Paintsville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000380 KY Part B Supplier - Clinic/Group Practice 5294720553 Receives reassigned benefits from 237 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Paintsville, KY; Pikeville, KY; Prestonsburg, KY; Salyersville, KY; Winchester, KY; Martin, KY; Ashland, KY; Belfry, KY…
O20191122001151 KY Part A Provider - Federally Qualified Health Center (FQHC) 5294720553 Practice locations: Paintsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184182180. Details of each certification follow.

Federally qualified health center certification: CCN 181160

Legal name
MOUNTAIN COMPREHENSIVE CARE CENTER INC
Doing business as
HOMEPLACE CLINIC PAINTSVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 6, 2019
Last certification
Nov 6, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 17, 1966 in KY
Enrollment address
1110 S Mayo TRL
Paintsville, KY 41240-1273

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Mt Comprehensive Care C48 organizations share this tax ID, including this one
Part of
Mt Comprehensive Care C

Other organizations with this tax ID 47

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

View all 47

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jim Vanover Individual Corporate OfficerChair Jan 10, 2013
Sara Daniels Individual Corporate OfficerBoard Member Jan 10, 2013
Ancil W Lewis Individual Corporate OfficerBoard Member Jan 10, 2013
Lynette Schindler Individual Corporate OfficerBoard Member Jan 10, 2013
Jackie Tackett Individual Corporate OfficerBoard Member Jan 10, 2013
Durward E Hale Individual Corporate OfficerBoard Member Jan 10, 2013
Paula Thompson Individual Corporate OfficerBoard Member Jan 10, 2013
Teresa Petot Individual Corporate OfficerBoard Member Jan 10, 2013
Shirley Ratcliff Individual Corporate OfficerBoard Member Jan 1, 2015
Amanda Looney Individual W-2 Managing EmployeeFinancial Manager Dec 6, 2025
Promod Bishnoi Individual Corporate DirectorCeo Jul 31, 2008

Practitioners & affiliated clinicians

Practitioners 6

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": "1552003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552262400000",
    "number": "1184182180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S MAYO TRL",
            "city": "PAINTSVILLE",
            "state": "KY",
            "postal_code": "412401273",
            "telephone_number": "606-789-3518",
            "fax_number": "606-789-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN COMPREHENSIVE CARE CENTER, INC.",
        "enumeration_date": "2019-03-08",
        "last_updated": "2019-03-11",
        "status": "A",
        "authorized_official_last_name": "CORDIAL",
        "authorized_official_first_name": "ROXANN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "606-886-8572"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homeplace Clinic Paintsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paintsville, KY

Sources for this page

Verify at the official NPI Registry.