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

PrimaryPlus Denham Clinic

Practice address

525 Tucker Dr
Maysville, KY 41056-9182

Phone

(606) 759-0002

NPI assigned

Mar 8, 2021

Last updated

Mar 8, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

LEWIS COUNTY PRIMARY CARE CENTER, INC.As reported in NPPES

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 names 1

• PrimaryPlus Denham Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306431614. Details of each certification follow.

• CCN B01015 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN B01015

Legal name

LEWIS COUNTY PRIMARY CARE CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 31, 2021

Last certification

Mar 31, 2021

Ownership / control type

For profit – corporation

Facility address

525 Tucker Dr
Maysville, KY 41056

Part of

Lewis County Primary Care Center Inc

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1306431614",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 TUCKER DR",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569182",
            "telephone_number": "606-759-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEWIS COUNTY PRIMARY CARE CENTER, INC.",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-02-18",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PrimaryPlus Denham Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lewis County Primary Care Center Inc (Maysville Pediatrics)
• Lewis County Primary Care Center Inc (PrimaryPlus)
• Lewis County Primary Care Center, Inc (PrimaryPlus Tucker Drive Pharmacy)
• Lewis County Primary Care Center, Inc. (PrimaryPlus)
• Lewis County Primary Care Center, Inc. (Maysville OB/GYN Family Health Center)
• Lewis County Primary Care Center, Inc. (PrimaryPlus Medical Specialties & Residency)
• Lewis County Primary Care Center, Inc. (Maysville OB GYN Family Health Center Pharmacy)
• Vincent Lewis
• Liberty Family Healthcare LLC
• Hannah Rose Liles, CSW

• Federally Qualified Health Center (FQHC) in Maysville, KY
• Providers in Maysville, 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 Mar 8, 2021; 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.