Lewis County Primary Care Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

LEWIS COUNTY PRIMARY CARE CENTER INC

Doing business as

Grayson Family Health Center
PrimaryPlus

Practice address

100 Bellefonte Dr
Grayson, KY 41143-1820

Phone

(606) 474-0669

Fax

(606) 474-0376

NPI assigned

Apr 17, 2020

Organization subpart

No

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

Authorized official

Name

Jerry Ugrin

Title

Ceo

Phone

(606) 796-3029

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Grayson Family Health Center Doing business as
• PrimaryPlus Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 181199

Legal name

PRIMARY PLUS – GRAYSON

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 17, 2020

Last certification

Jun 17, 2020

Ownership / control type

For profit – partnership

Facility address

100 Bellefonte Drive
Grayson, KY 41143

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1285254458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "VANCEBURG",
            "state": "KY",
            "postal_code": "411790550",
            "telephone_number": "606-796-3029",
            "fax_number": "606-202-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BELLEFONTE DR",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431820",
            "telephone_number": "606-474-0669",
            "fax_number": "606-474-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY PRIMARY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "UGRIN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-796-3029"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000268",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grayson Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PrimaryPlus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Grayson, KY
• Providers in Grayson, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.