NPIMap

Organization Active NPI

Breckinridge Health, Inc.

Doing business as Cloverport Health Clinic

  • Rural Health Clinic/Center
  • Cloverport, KY
National Provider Identifier
1245236900
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900053 Issued in KY
Legal business name
BRECKINRIDGE HEALTH, INC.
Doing business as
Cloverport Health Clinic
Practice address
215 Elm St
Cloverport, KY 40111-1324
Phone
(270) 788-3000
Fax
(270) 788-6201
NPI assigned
Jun 27, 2005
Last updated
Apr 30, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
BRECKINRIDGE HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Authorized official

Name
Mrs. Mandy J Butler, ARNPNPI 1215935549
Title
Nurse Practitioner
Phone
(270) 788-3000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 900053 KY
Rural Health Clinic/Center 261QR1300X 900053 KY Primary

Addresses

Primary practice location

215 Elm St
Cloverport, KY 40111-1324

Mailing address

215 Elm St
Cloverport, KY 40111-1324
Phone (270) 788-3000

Other names 1

  • Cloverport Health Clinic 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
O20100507000344 KY Part A Provider - Rural Health Clinic 0941106454 Practice locations: Cloverport, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245236900. Details of each certification follow.

Rural health clinic certification: CCN 183412

Legal name
BRECKINRIDGE HEALTH, INC.
Doing business as
CLOVERPORT RURAL HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 4, 1996
Last certification
Jul 27, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 24, 1947 in KY
Enrollment address
215 Elm Street
Cloverport, KY 40111-1324
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.

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
18D0909451Cloverport Health Clinic215 Elm Street, Cloverport, KY 40111Certificate of waiverMar 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Breckinridge Health Clinic22 organizations share this tax ID, including this one
Part of
Breckinridge Health Clinic

Other organizations with this tax ID 21

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

View all 21

Locations

215 Elm St
Cloverport, KY 40111
Phone (270) 788-3000

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Rebecca Pollock Individual Corporate DirectorBoard of Trustee Aug 1, 2020
Dottie Watson Individual Corporate DirectorBoard Member Apr 1, 1999
Faye Dowell Individual Corporate DirectorBoard of Trustee May 1, 2016
Jeffrey Robbins Individual Corporate DirectorBoard Member Feb 1, 2014
Mitchell Jackson Individual Corporate DirectorBoard of Trustee Feb 1, 2020
Holly Gregory Individual Corporate DirectorBoard of Trustee May 1, 2019
Tom Loughran Individual Corporate DirectorBoard of Trustee Jun 1, 2017
Angela Portman Individual Corporate OfficerCeo Jan 1, 2015
Operational/Managerial ControlCeo Jan 1, 2015 100%
Grayanne Jackson Individual Corporate DirectorBoard of Trustee Nov 1, 2019
Janice Elder Individual Corporate DirectorBoard of Trustee May 1, 2018
Kerry Kasey Individual Corporate DirectorBoard of Trustee Nov 1, 2019
Kim Flood Individual Corporate DirectorBoard of Trustee May 1, 2018
Saagar Patel Individual Corporate DirectorBoardof Trustee Member Mar 1, 2014
Layman Lucas Individual Corporate DirectorBoard of Trustee May 1, 2016
Joan Carman Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2010

Owners & managing parties with NPI records 1

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

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": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777507200000",
    "number": "1245236900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 ELM ST",
            "city": "CLOVERPORT",
            "state": "KY",
            "postal_code": "401111324",
            "telephone_number": "270-788-3000",
            "fax_number": "270-788-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 ELM ST",
            "city": "CLOVERPORT",
            "state": "KY",
            "postal_code": "401111324",
            "telephone_number": "270-788-3000",
            "fax_number": "270-788-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKINRIDGE HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRECKINRIDGE HEALTH, INC.",
        "enumeration_date": "2005-06-27",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "270-788-3000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "KY",
            "license": "900053",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cloverport Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloverport, KY

Sources for this page

Verify at the official NPI Registry.