NPIMap

Organization Active NPI

Breckinridge Health Inc

Doing business as McDaniels Family Care

  • Rural Health Clinic/Center
  • McDaniels, KY
National Provider Identifier
1235566332
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRECKINRIDGE HEALTH INC
Doing business as
McDaniels Family Care
Practice address
9798 S Highway 259
MC Daniels, KY 40152-7227
Phone
(270) 756-6655
NPI assigned
Oct 3, 2013
Last updated
Mar 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Authorized official

Name
Melissa S Arehart
Title
Credentialing Specialist
Phone
(317) 805-1042

Specialties & licenses 1

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

Addresses

Primary practice location

9798 S Highway 259
MC Daniels, KY 40152-7227

Mailing address

9798 S Highway 259
MC Daniels, KY 40152-7227
Phone (270) 902-4411

Other names 1

  • McDaniels Family Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031208000333 KY Part B Supplier - Clinic/Group Practice 0941106454 Receives reassigned benefits from 32 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hardinsburg, KY; McDaniels, KY; Irvington, KY; Cloverport, KY
O20140421000957 KY Part A Provider - Rural Health Clinic 0941106454 Practice locations: MC Daniels, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235566332. Details of each certification follow.

Rural health clinic certification: CCN 183487

Legal name
BRECKINRIDGE HEALTH, INC.
Doing business as
MCDANIELS FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 17, 2014
Last certification
Jun 17, 2014
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Nov 24, 1947 in KY
Enrollment address
9798S Highway 259
MC Daniels, KY 40152-7227
Related CCNs
181319

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Breckinridge Health Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dottie Watson Individual Corporate DirectorBoard Member/Secretary Aug 27, 2013
Faye Dowell Individual 5% Or Greater Indirect Ownership InterestBoard Member May 1, 2016 5%
Mitchell Jackson Individual 5% Or Greater Indirect Ownership InterestBoard Member Feb 1, 2022 5%
Holly Gregory Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 2022 5%
Tom Loughran Individual 5% Or Greater Indirect Ownership InterestBoard Member Jun 1, 2017 5%
Angela Portman Individual 5% Or Greater Direct Ownership InterestCeo Nov 1, 2013 5%
Corporate OfficerCeo Jan 1, 2015
Operational/Managerial ControlCeo Jan 1, 2015 5%
Kerry Kasey Individual 5% Or Greater Indirect Ownership InterestBoard Member Feb 1, 2018
Layman Lucas Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 2022 5%

Practitioners & affiliated clinicians

Practitioners 4

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": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1235566332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9798 S HIGHWAY 259",
            "city": "MC DANIELS",
            "state": "KY",
            "postal_code": "401527227",
            "telephone_number": "270-902-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9798 S HIGHWAY 259",
            "city": "MC DANIELS",
            "state": "KY",
            "postal_code": "401527227",
            "telephone_number": "270-756-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKINRIDGE HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "AREHART",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "317-805-1042"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McDaniels Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McDaniels, KY

Sources for this page

Verify at the official NPI Registry.