Active NPI
Jackson Hospital Corporation
Doing business as Kentucky River Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Jackson, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medicare Defined Swing Bed Hospital Unit
- License
- 100620
- Legal business name
- JACKSON HOSPITAL CORPORATION
- Doing business as
- Kentucky River Medical Center
- Practice address
- 540 Jett Dr
Jackson, KY 41339-9622 - Phone
- (606) 666-6000
- NPI assigned
- Sep 23, 2008
- Last updated
- Aug 11, 2020
- Organization subpart
- Yes
- Parent organization
- JACKSON HOSPITAL CORPORATION
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randy Michael Cooper
- Title
- SVP Finance Op/Authorized Official
- Phone
- (615) 221-3840
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 100620 | KY | Primary |
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 1
- Kentucky River Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241216001253 | KY | Part A Provider - Critical Access Hospital | 0345134318 | Practice locations: Jackson, KY |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1295985596. Details of each certification follow.
Hospital certification: CCN 18Z334
- Legal name
- JACKSON HOSPITAL CORPORATION
- Organization structure
- Corporation
- Enrollment address
- 540 Jett Dr
Jackson, KY 41339-9622
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Kentucky River Medical Center
- Critical Access Hospital
- Jackson, KY
- NPI 1346247962
Unit of hospital
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Beattyville Family Medical Clinic
- Rural Health Clinic/Center
- Beattyville, KY
- NPI 1083950414
0345134318
-
dba Kentucky River Medical Center
- Critical Access Hospital
- Jackson, KY
- NPI 1346247962
0345134318
-
dba Kentucky River Clinics
- Rural Health Clinic/Center
- Jackson, KY
- NPI 1912518978
0345134318
-
dba Beattyville Family Medical Clinic
- Nurse Practitioner
- Beattyville, KY
- NPI 1992044747
0345134318
National Provider Directory
National Provider Directory- Part of
- Community Medical Clini
Ownership & related parties
All disclosed owners & managing parties 19
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| 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
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Beattyville Family Medical Clinic | Rural health clinic | 5% Or Greater Direct Ownership Interest | Apr 29, 2016 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
dba Beattyville Family Medical Clinic
- Rural Health Clinic/Center
- Beattyville, KY
- NPI 1083950414
5% Or Greater Direct Ownership Interest
Facilities with the same owner 36
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Three Rivers Medical Center
- General Acute Care Hospital
- Louisa, KY
- NPI 1063484483
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Three Rivers Medical Center
- Psychiatric Hospital Unit
- Louisa, KY
- NPI 1356313407
Davidson Kempner Distressed Opportunities Fund LP, Davidson Kempner Distressed Opportunities International Cayman, Davidson Kempner Long-Term Distressed Opportunities Fund IV L, Davidson Kempner Long-Term Distressed Opps Intl IV Aiv LP, DK Distressed
-
dba Three Rivers Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Louisa, KY
- NPI 1952373276
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Beattyville Family Medical Clinic
- Rural Health Clinic/Center
- Beattyville, KY
- NPI 1083950414
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Kentucky River Medical Center
- Critical Access Hospital
- Jackson, KY
- NPI 1346247962
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Kentucky River Clinics
- Rural Health Clinic/Center
- Jackson, KY
- NPI 1912518978
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
- Rural Health Clinic/Center
- Louisa, KY
- NPI 1285301952
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
- Rural Health Clinic/Center
- Louisa, KY
- NPI 1376210047
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Three Rivers Family Practice - Riverview
- Rural Health Clinic/Center
- Louisa, KY
- NPI 1437824406
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Three Rivers Family Practice - Inez
- Rural Health Clinic/Center
- Inez, KY
- NPI 1699038737
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
- Rural Health Clinic/Center
- Alpine, TX
- NPI 1275988669
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Big Bend Regional Medical Center
- Critical Access Hospital
- Alpine, TX
- NPI 1356312243
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
Practitioners & affiliated clinicians
Practitioners 19
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Campton, KY
- NPI 1023773132
-
- Cardiovascular Disease Physician
- Hazard, KY
- NPI 1760421564
-
- Family Medicine Physician
- Jackson, KY
- NPI 1003815390
-
- Family Nurse Practitioner
- Jackson, KY
- NPI 1992436166
-
- Family Medicine Physician
- Beattyville, KY
- NPI 1699071480
-
- Family Nurse Practitioner
- Jackson, KY
- NPI 1053960534
-
- Family Nurse Practitioner
- Jackson, KY
- NPI 1083145866
-
- Internal Medicine Physician
- Jackson, KY
- NPI 1083804041
-
- Interventional Pain Medicine Physician
- Winchester, KY
- NPI 1669674206
-
- Family Nurse Practitioner
- Hazard, KY
- NPI 1295283448
-
- Interventional Cardiology Physician
- Hazard, KY
- NPI 1487695250
-
- Family Nurse Practitioner
- Beattyville, KY
- NPI 1548517709
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"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, CRNA
- Steven Ray Howard, D.C.
- Krista Hubbard
- John F. Inserra Jr., LPCC
- Jackson ENT Clinic , PSC
- Jackson Hospital Corporation (Kentucky River Medical Center)
- Jackson Hospital Corporation (Kentucky River ER, Anesth, Radiology)
- Jackson Hospital Corporation (Kentucky River Medical Center)
- Jackson Hospital Corporation (Kentucky River Clinics)
- Jackson Independent School District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.