Jackson Hospital Corporation
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Jackson, KY
NPI 1295985596 · NPPES record last updated Aug 11, 2020
Key facts
- NPI
- 1295985596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 100620 (KY)
- Legal business name
- JACKSON HOSPITAL CORPORATION
- Practice address
- 540 Jett Dr
Jackson, KY 41339-9622 - Phone
- (606) 666-6000
- NPI assigned
- Sep 23, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- JACKSON HOSPITAL CORPORATION
Authorized official
- Name
- Randy Michael Cooper
- Title
- SVP Finance Op/Authorized Official
- Phone
- (615) 221-3840
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 36
Practitioners 19
-
Srinivasa R Appakondu, M.D.
-
Jerrica Duty, APRN
-
Rebecca Mae Holbrook, APRN
-
Aaron William Johnson, D.O.
-
Nageswara R Podapati, M.D.
-
Heather Renee Price, APRN
-
Summer Rochelle Shuler, APRN
-
Himachala R. Veligandla, M.D.
-
Radu Constantine, M.D.
-
Kristian Renee Allen, PMHNP-BC
-
Anand Modadugu, MD
-
Kathryn Ann Morgan, APRN
-
Deanna Lane Wright, APRN
-
Jillian Miriah McCagg, M.D.
-
Irfan Riaz Qureshi, M.D.
Affiliated clinicians 1
-
Amy Fowler, D.O
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Hospital certification: CCN 18Z334
- Legal name
- JACKSON HOSPITAL CORPORATION
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 540 Jett Dr
Jackson, KY 41339-9622
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Davidson Kempner Distressed Opportunities International Cayman |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 11.6% |
| Henry Kunath |
Corporate Officer |
Sep 6, 2023 | |
| Corporate Director |
Sep 6, 2023 | ||
| DK Distressed Opportunities Int LTD |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 13.2% |
| DK Ldoi IV Aggregate Holdco LP |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 11.8% |
| Davidson Kempner Long-Term Distressed Opportunities Fund IV L |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 6.1% |
| Quorum Health Corporation |
5% Or Greater Direct Ownership Interest | Apr 29, 2016 | 100% |
| DK Quincy Investor BT I LLC |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 7.9% |
| Davidson Kempner Long-Term Distressed Opps Intl IV Aiv LP |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 11.8% |
| Goldentree Distressed Onshore Master Fund III LP |
5% Or Greater Indirect Ownership Interest | Aug 5, 2020 | 8.5% |
| DK Quincy Investor BT II LLC |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 7.9% |
| Laura Fey |
Corporate Director |
Aug 27, 2019 | |
| Goldentree Select Offshore Intermediate Fund LP |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 5.44% |
| Goldentree Distressed Master Fund III LTD |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 11% |
| Quincy Health LLC |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 100% |
| Steven W Frantz |
Corporate Officer |
Aug 10, 2022 | |
| Corporate Director |
Aug 10, 2022 | ||
| Julie Manas |
Corporate Officer |
Aug 10, 2022 | |
| Corporate Director |
Aug 10, 2022 | ||
| Davidson Kempner Distressed Opportunities Fund LP |
5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 7.8% |
| Wanda Susie Morgan |
W-2 Managing Employee | Feb 22, 2019 | |
| Donald Esposito |
Corporate Officer |
Sep 16, 2021 | |
| Corporate Director |
Sep 16, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Beattyville Family Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Apr 29, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241216001253 | KY | Part a Provider - Critical Access Hospital | 0345134318 | Practice locations: Jackson, KY |
National Provider Directory
- Part of
- Stephen R Mitchell MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 100620 | KY | Yes |
Addresses
Primary practice location
540 Jett Dr
Jackson, KY 41339-9622
Mailing address
540 Jett Dr
Jackson, KY 41339-9622
Phone (606) 666-6000
Other names
- Kentucky River Medical Center
NPI Registry JSON
{
"created_epoch": "1222128000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597104000000",
"number": "1295985596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 JETT DR",
"city": "JACKSON",
"state": "KY",
"postal_code": "413399622",
"telephone_number": "606-666-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 JETT DR",
"city": "JACKSON",
"state": "KY",
"postal_code": "413399622",
"telephone_number": "606-666-6000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACKSON HOSPITAL CORPORATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "JACKSON HOSPITAL CORPORATION",
"enumeration_date": "2008-09-23",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A",
"authorized_official_last_name": "COOPER",
"authorized_official_first_name": "RANDY",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "SVP FINANCE OP/AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "615-221-3840"
},
"taxonomies": [
{
"code": "275N00000X",
"taxonomy_group": "",
"desc": "Medicare Defined Swing Bed Unit",
"state": "KY",
"license": "100620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Kentucky River Medical Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kentucky River Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jackson, KY
- Matthew E Holloway
- Steven Ray Howard
- Krista Hubbard
- John F. Inserra Jr.
- Jackson ENT Clinic , PSC
- Jackson Hospital Corporation
- Jackson Hospital Corporation
- Jackson Hospital Corporation
- Jackson Hospital Corporation
- Jackson Independent School District
All providers in Jackson, KY · Medicare Defined Swing Bed Hospital Unit in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.