NPIMap

Organization Active NPI

Means Adult Primary Care Clinic of Kentucky PLLC

  • Rural Health Clinic/Center
  • Mt Sterling, KY
National Provider Identifier
1205935814
Registry record updated May 10, 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
148 Skyview Dr.
Mt Sterling, KY 40353-1300
Phone
(859) 499-0717
Fax
(859) 499-0926
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Rezkalla Butros, MDNPI 1023037082
Title
Owner
Phone
(859) 499-0717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

148 Skyview Dr.
Mt Sterling, KY 40353-1300

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7100636790MedicaidKY

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
Practice locations: Mt Sterling, KY; Winchester, KY; Richmond, KY
O20190812002291 KY Part A Provider - Rural Health Clinic 5395642177 Practice locations: Mount Sterling, KY

Rural health clinic certification: CCN 183839

Legal name
MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 5, 2019
Last certification
Sep 5, 2019
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Feb 12, 2003 in KY
Enrollment address
148 Skyview Dr
Mount Sterling, KY 40353-1496

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
18D1008738Means Adult Primary Care Clinic148 Skyview Drive, Mount Sterling, KY 40353Certificate of waiverJan 26, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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 InterestMD Jul 25, 2019 100%
Corporate OfficerPresident Jul 25, 2019 100%
W-2 Managing EmployeeMD; Jul 25, 2019 100%
Operational/Managerial Control Jul 25, 2019 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Rezkalla Butros, MD
    • Internal Medicine Physician
    • Mt. Sterling, KY
    • NPI 1023037082

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1205935814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 SKYVIEW DR",
            "city": "MT 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": "148 SKYVIEW DR.",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531300",
            "telephone_number": "859-499-0717",
            "fax_number": "859-499-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEANS ADULT PRIMARY CARE CLINIC OF KENTUCKY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "BUTROS",
        "authorized_official_first_name": "REZKALLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-499-0717",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100636790",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Sterling, KY

Sources for this page

Verify at the official NPI Registry.