Clemente V. Zulueta, Jr., MD, PLLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

CLEMENTE V. ZULUETA, JR., MD, PLLC

Practice address

95 Jackson HTS
Ste 201
Jackson, KY 41339-6500

Phone

(606) 693-1078

Fax

(606) 693-1079

NPI assigned

Aug 9, 2006

Last updated

Jul 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clemente V. Zulueta Jr., MDNPI 1831109743

Title

Owner

Phone

(606) 693-1078

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275543175. Details of each certification follow.

• CCN B03845 Rural health clinic · Active · Details

Rural health clinic certification: CCN B03845

Legal name

CLEMENTE V. ZULUETA, JR., MD, PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 15, 2021

Last certification

Sep 15, 2021

Ownership / control type

1A

Organization structure

LLCProprietary

Enrollment address

726 Highway 15 N
Jackson, KY 41339-8601

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Owners & managing parties with NPI records 1

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

• Clemente V. Zulueta Jr., MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Jackson, KY
  • NPI 1831109743

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 2

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.

• Clemente V. Zulueta Jr., MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Jackson, KY
  • NPI 1831109743
  Medicare reassignment Care Compare group NPD Authorized official
• Elizabeth Potter, ARNP

  • Family Nurse Practitioner
  • West Liberty, KY
  • NPI 1154478162
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1275543175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 908",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413390908",
            "telephone_number": "606-693-1078",
            "fax_number": "606-693-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 JACKSON HTS",
            "address_2": "STE 201",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413396500",
            "telephone_number": "606-693-1078",
            "fax_number": "606-693-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMENTE V. ZULUETA, JR., MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "ZULUETA",
        "authorized_official_first_name": "CLEMENTE",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-693-1078",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31-000847",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerri Campbell, NP
• Jerry Lee Campbell Jr., APRN
• Jessica Renee Carlington, LPCA
• Central Kentucky Therapy Services, PLLC
• Darlene Childers
• Allie Clevenger, PA-C
• Patricia A Cockerham, LCSW
• Jessica Collins, LCSW
• Ida Combs
• Kelsea B Combs, PA-C

• Endocrinology, Diabetes & Metabolism Physician in Jackson, KY
• Providers in Jackson, KY by specialty
• Endocrinology, Diabetes & Metabolism Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.